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Impact of Previous Stroke on Clinical Outcome in Elderly Patients With Nonvalvular Atrial Fibrillation: ANAFIE

Takeshi Yoshimoto1,2, Kazunori Toyoda3, Masafumi Ihara1

  • 1Department of Neurology (T. Yoshimoto, M.I.), National Cerebral and Cardiovascular Center, Suita, Japan.

Stroke
|April 20, 2022
PubMed

Insights

Elderly patients with nonvalvular atrial fibrillation and prior stroke/TIA face higher risks of stroke, bleeding, and death. Direct oral anticoagulants reduced hemorrhagic events compared to warfarin in these patients.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Nonvalvular atrial fibrillation (NVAF) is a common condition in the elderly.
  • Stroke and transient ischemic attack (TIA) are significant complications of NVAF.
  • Understanding long-term event incidence in elderly NVAF patients based on stroke history and anticoagulation is crucial.

Purpose of the Study:

  • To determine long-term event incidence in elderly NVAF patients.
  • To compare outcomes between NVAF patients with and without a history of stroke/TIA.
  • To evaluate the safety and efficacy of direct oral anticoagulants (DOACs) versus warfarin in NVAF patients with prior ischemic stroke/TIA.

Main Methods:

  • Prospective, multicenter, observational study of NVAF patients aged ≥75 years.
  • Patients were divided into groups based on history of stroke/TIA.
  • Primary endpoint: stroke/systemic embolism within 2 years. Secondary endpoints: major bleeding and all-cause death within 2 years. Cox models were used for analysis.

Main Results:

  • Over 32,000 patients were analyzed; 22.6% had a history of stroke/TIA.
  • Patients with prior stroke/TIA had higher risks of stroke/systemic embolism, major bleeding, and all-cause death.
  • Among patients with prior ischemic stroke/TIA, DOACs were associated with lower risks of major bleeding, intracranial hemorrhage, and cardiovascular death compared to warfarin.

Conclusions:

  • Elderly NVAF patients with a history of stroke/TIA experience more subsequent ischemic and hemorrhagic events.
  • DOACs demonstrate a favorable safety profile regarding hemorrhagic events in NVAF patients with prior ischemic stroke/TIA compared to warfarin.
Abstract

Keywords:
atrial fibrillationcardioembolismdirect oral anticoagulantselderlyintracranial hemorrhagestroke

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