Residual Risk of Recurrent Stroke Despite Anticoagulation in Patients With Atrial Fibrillation: A Systematic Review...

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• Atrial fibrillation (AF) is a major risk factor for stroke.
• Oral anticoagulants (OAC) are prescribed to mitigate this risk.
• However, the residual risk of recurrent stroke in AF patients remains a significant concern.

Purpose of the Study:

• To systematically review and meta-analyze the incidence of recurrent stroke in patients with AF.
• To quantify the residual risk of ischemic stroke and intra-cerebral hemorrhage (ICH) in this population.
• To assess stroke recurrence risk in patients who experienced stroke despite OAC treatment.

Main Methods:

• Systematic search of Ovid MEDLINE and Embase databases.
• Inclusion of studies with prior ischemic stroke and AF, reporting recurrent stroke incidence.
• Pooled incidence rates using random-effects meta-analysis and quality assessment via the Quality In Prognosis Studies tool.

Main Results:

• Analysis of 23 studies with 78,733 patients and over 140,000 years of follow-up.
• Pooled incidence of recurrent ischemic stroke was 3.75% per year, higher in observational studies (4.20%) than RCTs (2.26%).
• Recurrent stroke risk was 4.88% per year, ICH risk was 0.58% per year. Patients on OAC had a 7.20% ischemic stroke recurrence risk.

Conclusions:

• A significant residual risk of recurrent stroke persists in AF patients despite contemporary OAC therapy.
• An estimated 1 in 6 AF patients may experience recurrent ischemic stroke within 5 years.
• Urgent need exists for enhanced understanding of recurrence mechanisms, improved risk stratification, and novel secondary prevention strategies.