Key result
Discharge statin therapy is linked to ~45% lower 90-day mortality after AF-related breakthrough stroke.
Why the study?
Secondary stroke prevention in patients with AF who experience an ischemic stroke despite oral anticoagulation remains challenging, and whether adjunctive statin therapy at discharge reduces early vascular risk and 90-day mortality in this high-risk population required evaluation.
Does statin therapy at hospital discharge reduce 90-day all-cause mortality in patients with atrial fibrillation experiencing a breakthrough ischemic stroke despite continuous oral anticoagulation?
Cohort (n=1,442)
Yes
Does statin therapy at hospital discharge reduce 90-day all-cause mortality in patients with atrial fibrillation experiencing a breakthrough ischemic stroke despite continuous oral anticoagulation?
In patients with atrial fibrillation who suffer an ischemic stroke despite oral anticoagulation, discharge statin therapy is associated with a significant reduction in 90-day all-cause mortality without increasing short-term bleeding risk.
Answers are grounded in this paper and cite their sources.
Statin at discharge was associated with lower 90-day mortality in anticoagulated AF stroke; hypothesis-generating and should not yet change practice.
Background Secondary stroke prevention in patients with atrial fibrillation (AF) who experience an ischemic stroke (IS) despite oral anticoagulation remains challenging, and strategies have focused on antithrombotic optimization or left atrial appendage occlusion. Adjunctive statin therapy might reduce early vascular risk and mortality in this high-risk population. Objectives To evaluate the association between statin therapy at hospital discharge and 90-day all-cause death (primary outcome) in patients with AF experiencing IS despite oral anticoagulation. Design Multicenter, retrospective, observational cohort study within the ASPERA-R initiative. Methods Consecutive adults admitted between February 2020 and February 2025 with IS occurring during continuous oral anticoagulation for AF were included. Time-to-event analyses were landmarked at discharge to minimize immortal-time bias. Secondary outcomes were a composite vascular outcome (recurrent IS, transient ischemic attack (TIA), or vascular death) and recurrent IS/TIA; moderate-to-severe bleeding and intracranial hemorrhage (ICH) were assessed for safety. Inverse probability weighting (IPW) on a prespecified propensity score addressed confounding by indication, and weighted Cox models were fitted, with sensitivity analyses for the primary outcome. Results Among 1,442 patients discharged alive, 1,016 (70.5%) received statins at discharge. After weighting, propensity-score covariates were balanced. Over 90 days, statin therapy was associated with lower all-cause mortality (9.6% vs. 19.2%; HR 0.55, 95% CI 0.39-0.79). The composite vascular outcome showed a directionally similar but borderline association (HR 0.63, 95% CI 0.40-1.00); recurrent IS/TIA was not associated. Moderate-to-severe bleeding and ICH were rare and did not differ between groups. The mortality association was consistent across sensitivity analyses. Conclusion In AF patients with IS despite oral anticoagulation, statin therapy at discharge was associated with lower 90-day all-cause mortality, without increased short-term bleeding. Given the observational design, these hypothesis-generating findings support prospective evaluation of statins in this population.
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Merlino et al. (2026) conducted a cohort in Ischemic stroke during continuous oral anticoagulation for atrial fibrillation (n=1,442). Statin therapy at hospital discharge vs. No statin therapy at hospital discharge was evaluated on 90-day all-cause death (HR 0.55, 95% CI 0.39-0.79). Statin therapy at discharge was associated with lower 90-day all-cause mortality after breakthrough ischemic stroke in atrial fibrillation (9.6% vs 19.2%; HR 0.55, 95% CI 0.39-0.79).
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