Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke
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Updated: Nov 17, 2025
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Published on: February 28, 2012
Mi-Yeon Eun1, Jae-Young Kim2,3, Yang-Ha Hwang4
1Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Insights
Adhering to European Society of Cardiology (ESC) guidelines for oral anticoagulant therapy in atrial fibrillation (AF) patients after ischemic stroke significantly reduced stroke recurrence. This ESC guideline-matched therapy proved more effective than non-matched treatments.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Atrial fibrillation (AF) is a significant risk factor for ischemic stroke.
- Oral anticoagulant therapy (OAT) is crucial for stroke prevention in AF patients.
- Adherence to treatment guidelines is essential for optimal patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of European Society of Cardiology (ESC) guideline-matched OAT.
- To assess outcome events and bleeding complications in AF patients post-ischemic stroke.
- To compare guideline-adherent OAT versus non-adherent OAT in this patient population.
Main Methods:
- A nationwide multicenter registry (K-ATTENTION) of acute ischemic stroke and AF patients (2013-2015).
- Patients were categorized into ESC guideline-matched and non-matched OAT groups.
- Propensity score matching and logistic regression were used to analyze outcomes, including stroke recurrence and major bleeding events within 90 days.
Main Results:
- Among 1,126 matched patients, the ESC guideline-matched group showed a significantly lower risk of any recurrent stroke (1.4% vs. 3.4%).
- The risk of recurrent ischemic stroke was also lower in the guideline-matched group (0.9% vs. 2.7%).
- No significant differences were observed in other secondary outcomes, including major bleeding events.
Conclusions:
- ESC guideline-matched OAT is associated with a reduced risk of recurrent stroke in patients with acute ischemic stroke and AF.
- Adherence to ESC guidelines for OAT in AF patients post-stroke improves therapeutic efficacy.
- The findings support the implementation of guideline-directed anticoagulant therapy.
Background And Purpose:
To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF).
Methods:
Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered.
Results:
Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups.
Conclusions:
ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.
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