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April 17, 2023Annals of Neurology

Pre-stroke OAC adjustment eliminates the higher recurrent stroke risk of known versus post-stroke detected AF.

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Why the study?

Does atrial fibrillation detected after stroke (AFDAS) have a different risk of ischemic stroke recurrence compared to known AF when adjusting for prior oral anticoagulation?

Design

Editorial

Key result

Adjusting for pre-stroke oral anticoagulation eliminated the higher hazard for ischemic stroke recurrence previously associated with known atrial fibrillation compared to post-stroke detected AF.

Authors

SYShadi YaghiLSLee H. Schwamm

Discussion

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Overview

Pre-stroke anticoagulation explains apparent AF-type differences in recurrence; leaves open independent effects of detection timing and requires prospective validation.

Structured PICO

Does atrial fibrillation detected after stroke (AFDAS) have a different risk of ischemic stroke recurrence compared to known AF when adjusting for prior oral anticoagulation?

P
Population
Patients with acute ischemic stroke in the setting of atrial fibrillation (comparing atrial fibrillation detected after stroke [AFDAS] versus known AF)
E
Exposure
Oral anticoagulation (OAC)
C
Comparator
No oral anticoagulation / Known AF
O
Outcome
Ischemic stroke recurrencehard clinical

The apparent higher stroke recurrence risk in known AF compared to AF detected after stroke is likely confounded by pre-stroke oral anticoagulation and higher prevalence of vascular risk factors, suggesting both entities warrant similar secondary prevention strategies.

Limitations

  • Lack of data on atrial fibrillation burden
  • Diagnostic evaluation performed was not reported, leaving potential residual confounding from underlying atherosclerosis or malignancy
  • Lack of data on AF burden
  • Diagnostic evaluation performed was not reported, leading to potential residual confounding from underlying atherosclerosis or malignancy

Cite This Study

Yaghi et al. (2023) conducted an editorial in Acute ischemic stroke and atrial fibrillation. Atrial fibrillation detected after stroke (AFDAS) vs. Known atrial fibrillation prior to stroke was evaluated on Ischemic stroke recurrence. Adjusting for pre-stroke oral anticoagulation eliminated the higher hazard for ischemic stroke recurrence previously associated with known atrial fibrillation compared to post-stroke detected AF.

synapsesocial.com/papers/6aa2862548edd87d04240b45https://doi.org/10.1002/ana.26663
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardioembolic Breakthrough Stroke: When Anticoagulation Fails, Is Left Atrial Appendage Closure the Next Step?2025
  2. 2Differences between atrial fibrillation diagnosed before and after stroke: A large real-world cohort study2024 · 9 citations
  3. 3Left atrial appendage occluders—new hope for stroke prevention in high-risk patients2022 · 1 citations
  4. 4Acute care and secondary prevention of stroke with newly detected versus known atrial fibrillation2022 · 14 citations
  5. 5Atrial Fibrillation Detected before or after Stroke: Role of Anticoagulation2023 · 21 citations