Key result
Prior oral anticoagulation in patients with atrial fibrillation who suffered an ischemic stroke was associated with an increased risk of recurrent acute ischemic stroke (HR 1.6) compared to those without prior anticoagulation.
Why the study?
It was unknown whether patients with atrial fibrillation experiencing ischemic stroke despite oral anticoagulation are at increased risk for recurrent stroke, or how secondary prevention should be managed.
Does prior oral anticoagulation or changing the type of oral anticoagulation affect the risk of recurrent acute ischemic stroke in patients with atrial fibrillation and recent cerebral ischemia?
Population
5,413 patients with AF and recent cerebral ischemia across 7 prospective cohort studies
Comparison
OAC prior vs OAC naive, and OAC changed vs OAC unchanged
Design
Individual patient data pooled analysis of 7 prospective cohort studies
Follow-up
6,128 patient‐years
Authors
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Switching OAC type after breakthrough stroke may not lower recurrence; leaves open better strategies and should not yet change practice.
Cohort (n=5,314)
Yes
Does prior oral anticoagulation or changing the type of oral anticoagulation affect the risk of recurrent acute ischemic stroke in patients with atrial fibrillation and recent cerebral ischemia?
Hazard Ratio: 1.6 (95% CI 1.2–2.3)
Absolute Event Rate: 8.9% vs 3.9%
p-value: p=0.005
Patients with atrial fibrillation who experience an ischemic stroke despite oral anticoagulation are at higher risk for recurrent stroke, and changing the type of anticoagulant does not appear to reduce this risk.
Seiffge et al. (2020) conducted a cohort in Atrial fibrillation and recent cerebral ischemia (n=5,314). Prior oral anticoagulation (OAC prior) vs. No prior oral anticoagulation (OAC naive) was evaluated on Recurrent acute ischemic stroke (AIS) (HR 1.6, 95% CI 1.2-2.3, p=0.005). Prior oral anticoagulation in patients with atrial fibrillation who suffered an ischemic stroke was associated with an increased risk of recurrent acute ischemic stroke (HR 1.6) compared to those without prior anticoagulation.
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