Key result
Oral anticoagulation for secondary prevention was associated with a favorable 3-month functional outcome independently of atrial fibrillation subtype (OR 7.60; 95% CI 3.42-16.88).
Why the study?
AF detected after stroke may include neurogenic arrhythmias distinct from known AF, but the clinical course, outcomes, and value of secondary prevention OAC by AF subtype were unclear.
Does oral anticoagulation improve 3-month functional outcomes in acute ischemic stroke patients with newly detected versus known atrial fibrillation?
Cohort (n=822)
Does oral anticoagulation improve 3-month functional outcomes in acute ischemic stroke patients with newly detected versus known atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Oral anticoagulation for secondary prevention in acute ischemic stroke patients with atrial fibrillation significantly improves 3-month functional outcomes, regardless of whether the AF was known prior to the stroke or detected afterwards.
BACKGROUND AND PURPOSE: Atrial fibrillation (AF) in stroke patients can be classified as either "known AF" (KAF), defined as AF confirmed before stroke onset, or "AF detected after stroke" (AFDAS), defined as AF diagnosed after stroke onset. While KAF is considered primarily cardiogenic, AFDAS includes patients with stroke-triggered neurogenic arrhythmias. This study aimed to investigate the clinical course of stroke, functional outcomes and the value of oral anticoagulation (OAC) for secondary prevention according to AF subtype. METHODS: Acute ischemic stroke patients were consecutively enrolled and AF was classified as AFDAS or KAF. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and 3-month functional outcomes were measured on the modified Rankin scale. Inverse probability weighting was applied to adjust for baseline confounders in patients with AFDAS and KAF. Multivariate logistic regression models were calculated to investigate the value of OAC for secondary prevention. RESULTS: A total of 822 stroke patients with AF were included, of whom 234 patients (28.5%) had AFDAS. AFDAS patients had a lower prevalence of coronary artery disease, heart failure, and sustained AF, but higher rates of large vessel occlusion compared to KAF patients. NIHSS scores were lower in patients on pre-stroke anticoagulation. OAC for secondary prevention was associated with favorable 3-month functional outcome (odds ratio 7.60, 95% confidence interval 3.42-16.88) independently of AF subtype. The rate of stroke recurrence did not differ significantly. CONCLUSIONS: Clinical characteristics suggest that AFDAS might comprise a distinct pathophysiological and clinical entity among stroke patients with AF. The benefit of anticoagulation for secondary prevention was not affected by AF subtype.
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Wang et al. (2022) conducted a cohort in Acute ischemic stroke with atrial fibrillation (n=822). Oral anticoagulation (OAC) vs. No oral anticoagulation was evaluated on Favorable 3-month functional outcome (OR 7.60, 95% CI 3.42-16.88). Oral anticoagulation for secondary prevention was associated with a favorable 3-month functional outcome independently of atrial fibrillation subtype (OR 7.60; 95% CI 3.42-16.88).
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