Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study
dc.creator | Paciaroni M., Caso V., Agnelli G., Mosconi M.G., Giustozzi M., Seiffge D.J., Engelter S.T., Lyrer P., Polymeris A.A., Kriemler L., Zietz A., Putaala J., Strbian D., Tomppo L., Michel P., Strambo D., Salerno A., Remillard S., Buehrer M., Bavaud O., Vanacker P., Zuurbier S., Yperzeele L., Loos C.M.J., Cappellari M., Emiliani A., Zedde M., Abdul-Rahim A., Dawson J., Cronshaw R., Schirinzi E., Del Sette M., Stretz C., Kala N., Reznik M., Schomer A., Grory B.M., Jayaraman M., Mctaggart R., Yaghi S., Furie K.L., Masotti L., Grifoni E., Toni D., Risitano A., Falcou A., Petraglia L., Lotti E.M., Padroni M., Pavolucci L., Lochner P., Silvestrelli G., Ciccone A., Alberti A., Venti M., Traballi L., Urbini C., Kargiotis O., Rocco A., Diomedi M., Marcheselli S., Caliandro P., Zauli A., Reale G., Antonenko K., Rota E., Tassinari T., Saia V., Palmerini F., Aridon P., Arnao V., Monaco S., Cottone S., Baldi A., D'Amore C., Ageno W., Pegoraro S., Ntaios G., Sagris D., Giannopoulos S., Kosmidou M., Ntais E., Romoli M., Pantoni L., Rosa S., Bertora P., Chiti A., Canavero I., Saggese C.E., Plocco M., Giorli E., Palaiodimou L., Bakola E., Tsivgoulis G., Bandini F., Gasparro A., Terruso V., Mannino M., Pezzini A., Ornello R., Sacco S., Popovic N., Scoditti U., Genovese A., Denti L., Flomin Y., Mancuso M., Ferrari E., Caselli M.C., Ulivi L., Giannini N., De Marchis G.M. | en |
dc.date.accessioned | 2023-01-31T09:41:17Z | |
dc.date.available | 2023-01-31T09:41:17Z | |
dc.date.issued | 2022 | |
dc.identifier | 10.1161/STROKEAHA.121.038239 | |
dc.identifier.issn | 00392499 | |
dc.identifier.uri | http://hdl.handle.net/11615/77422 | |
dc.description.abstract | BACKGROUND: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. METHODS: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. RESULTS: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA2DS2-VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P=0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P=0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P=0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P=0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P=0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). CONCLUSIONS: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding. © 2022 American Heart Association, Inc. | en |
dc.language.iso | en | en |
dc.source | Stroke | en |
dc.source.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85135281933&doi=10.1161%2fSTROKEAHA.121.038239&partnerID=40&md5=66fd1cd7a8ce00381ac49cf67b0fc3be | |
dc.subject | anticoagulant agent | en |
dc.subject | antithrombocytic agent | en |
dc.subject | blood clotting factor 10a inhibitor | en |
dc.subject | dabigatran | en |
dc.subject | hemoglobin | en |
dc.subject | low molecular weight heparin | en |
dc.subject | nonvitamin K antagonist oral anticoagulant | en |
dc.subject | unclassified drug | en |
dc.subject | warfarin | en |
dc.subject | anticoagulant agent | en |
dc.subject | acute ischemic stroke | en |
dc.subject | adult | en |
dc.subject | age | en |
dc.subject | alcohol abuse | en |
dc.subject | anticoagulant therapy | en |
dc.subject | Article | en |
dc.subject | atherosclerosis small vessel disease cardiac pathology other causes and dissection classification | en |
dc.subject | atrial fibrillation | en |
dc.subject | bleeding | en |
dc.subject | blood transfusion | en |
dc.subject | blood vessel occlusion | en |
dc.subject | brain hemorrhage | en |
dc.subject | cardioembolic stroke | en |
dc.subject | CHA2DS2-VASc score | en |
dc.subject | cohort analysis | en |
dc.subject | computer assisted tomography | en |
dc.subject | controlled study | en |
dc.subject | disease classification | en |
dc.subject | drug substitution | en |
dc.subject | drug withdrawal | en |
dc.subject | embolism | en |
dc.subject | Europe | en |
dc.subject | explanatory variable | en |
dc.subject | female | en |
dc.subject | follow up | en |
dc.subject | HAS BLED score | en |
dc.subject | hemoglobin blood level | en |
dc.subject | human | en |
dc.subject | hyperlipidemia | en |
dc.subject | hypertension | en |
dc.subject | incidence | en |
dc.subject | ischemic stroke | en |
dc.subject | Kaplan Meier method | en |
dc.subject | low drug dose | en |
dc.subject | major clinical study | en |
dc.subject | male | en |
dc.subject | malignant neoplasm | en |
dc.subject | medical history | en |
dc.subject | multicenter study | en |
dc.subject | neuroimaging | en |
dc.subject | nuclear magnetic resonance imaging | en |
dc.subject | observational study | en |
dc.subject | outcome assessment | en |
dc.subject | paroxysmal atrial fibrillation | en |
dc.subject | propensity score | en |
dc.subject | proportional hazards model | en |
dc.subject | prospective study | en |
dc.subject | Rankin scale | en |
dc.subject | recurrent disease | en |
dc.subject | risk assessment | en |
dc.subject | secondary prevention | en |
dc.subject | smoking | en |
dc.subject | stroke unit | en |
dc.subject | subarachnoid hemorrhage | en |
dc.subject | survival | en |
dc.subject | telephone interview | en |
dc.subject | thromboembolism | en |
dc.subject | transient ischemic attack | en |
dc.subject | United States | en |
dc.subject | atrial fibrillation | en |
dc.subject | bleeding | en |
dc.subject | brain ischemia | en |
dc.subject | cerebrovascular accident | en |
dc.subject | clinical trial | en |
dc.subject | complication | en |
dc.subject | oral drug administration | en |
dc.subject | risk factor | en |
dc.subject | Administration, Oral | en |
dc.subject | Anticoagulants | en |
dc.subject | Atrial Fibrillation | en |
dc.subject | Brain Ischemia | en |
dc.subject | Hemorrhage | en |
dc.subject | Humans | en |
dc.subject | Ischemic Stroke | en |
dc.subject | Prospective Studies | en |
dc.subject | Risk Factors | en |
dc.subject | Stroke | en |
dc.subject | Wolters Kluwer Health | en |
dc.title | Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study | en |
dc.type | journalArticle | en |
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