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What Do Anticoagulants Say about Microemboli?

Serkan Demir1, Mehmet F Ozdag1, Mustafa T Kendirli1

  • 1Department of Neurology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|September 19, 2015
PubMed
Summary

This study found no significant difference in microembolic signals (MES) frequency among warfarin, rivaroxaban, and dabigatran treatments for atrial fibrillation (AF) patients. MES screening can help assess stroke risk during anticoagulant therapy.

Keywords:
Transcranial Doppler ultrasonographydabigatran etexilateembolusmiddle cerebral arteryrivaroxabanwarfarin

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Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Atrial fibrillation (AF) increases stroke risk.
  • Anticoagulant therapy is crucial for managing AF-related stroke risk.
  • Microembolic signals (MES) detected by transcranial Doppler ultrasound (TCD) may indicate embolic events.

Purpose of the Study:

  • To evaluate and compare the frequency of microembolic signals (MES) in patients with nonvalvular atrial fibrillation (AF) undergoing treatment with warfarin, rivaroxaban, or dabigatran.
  • To assess the utility of MES screening in predicting stroke risk in AF patients on anticoagulant therapy.

Main Methods:

  • A total of 215 patients with nonvalvular AF and a history of stroke were included.
  • Patients were treated with warfarin (46%), rivaroxaban (31%), or dabigatran (23%).
  • Microembolic signals (MES) were monitored bilaterally using transcranial Doppler (TCD) for 30 minutes; CHA2DS2VASc scores and INR (for warfarin) were recorded.

Main Results:

  • The incidence of emboli was 32% for warfarin, 36% for rivaroxaban, and 35% for dabigatran.
  • No statistically significant differences in MES frequency were observed between the anticoagulant treatment groups.
  • A positive correlation between CHA2DS2VASc scores and MES, and a negative correlation between INR and MES in the warfarin group were noted.

Conclusions:

  • Anticoagulant therapy for AF does not significantly alter MES frequency across different drug classes.
  • MES screening using TCD can serve as a valuable tool for assessing individual stroke risk in AF patients.
  • Further research may refine the role of MES monitoring in optimizing anticoagulant strategies for stroke prevention.