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Atrial Fibrillation Detected before or after Stroke: Role of Anticoagulation

Flurina Lyrer1, Annaelle Zietz1,2, David J Seiffge3

  • 1Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.

Annals of Neurology
|March 28, 2023
PubMed

Insights

Pre-existing anticoagulation, not atrial fibrillation known before stroke, independently increases ischemic stroke recurrence risk. Future research should focus on stroke causes despite anticoagulation for better prevention.

Area of Science:

  • Neurology
  • Cardiology
  • Epidemiology

Background:

  • Atrial fibrillation (AF) known before ischemic stroke (KAF) is thought to have higher recurrence risk than AF detected after stroke (AFDAS).
  • This potential risk difference may be confounded by pre-existing anticoagulation, common in KAF and linked to high stroke recurrence risk.

Purpose of the Study:

  • To investigate the independent prognostic importance of AF category (KAF vs. AFDAS) and pre-existing anticoagulation on ischemic stroke recurrence.
  • To compare stroke recurrence and all-cause death risks between KAF and AFDAS patients, and between anticoagulation-naïve and previously anticoagulated patients.

Main Methods:

  • Individual patient data analysis from 5 prospective cohorts of anticoagulated patients post-AF-associated ischemic stroke.
  • Multivariable Cox and Fine-Gray models used to assess outcomes, comparing AF category and anticoagulation status.
  • Goodness-of-fit statistics employed to evaluate model performance.

Main Results:

  • Of 4,357 patients, 57% had KAF and 29% were previously anticoagulated.
  • Pre-existing anticoagulation, but not KAF, was independently associated with higher ischemic stroke recurrence hazard.
  • Models with pre-existing anticoagulation showed better fit than those with AF category; neither factor independently predicted death.

Conclusions:

  • KAF and AFDAS are not distinct prognostic entities regarding stroke recurrence.
  • Pre-existing anticoagulation is a key factor in stroke recurrence risk, not the timing of AF diagnosis relative to stroke.
  • Future research should target causes of stroke despite anticoagulation for improved preventive strategies.
Abstract

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