First-Ever Stroke Outcomes in Patients with Atrial Fibrillation: A Retrospective Cross-Sectional Study.

Area of Science:

• Cardiology
• Neurology
• Pharmacology

Background:

• Atrial fibrillation (AF) is a primary risk factor for cardioembolic stroke, leading to poorer outcomes.
• Antithrombotic medications are crucial for stroke prevention in high-risk patients.

Purpose of the Study:

• To evaluate the outcomes of first-ever ischemic stroke in patients with AF based on prior antithrombotic therapy.
• To compare functional outcomes and stroke severity across different treatment groups.

Main Methods:

• Cross-sectional study of 754 patients with first-ever ischemic stroke and AF.
• Data collected included stroke risk factors, CHADS2 score, warfarin's INR, stroke localization, severity (NIHSS), and functional outcome (mRS).
• Patients were categorized into three groups: warfarin, acetylsalicylic acid (aspirin), and no prior antithrombotic therapy.

Main Results:

• Warfarin users were significantly younger and had a better functional outcome (median mRS 4) compared to antiplatelet (mRS 5) or no therapy (mRS 5) groups.
• While not statistically significant, warfarin users showed lower median NIHSS scores (10) versus antiplatelet (12) or no therapy (12).
• Previously unknown AF diagnosis occurred in 31% of subjects; stroke risk factors were less prevalent in the untreated group.

Conclusions:

• Prior anticoagulant therapy, particularly warfarin, is associated with more favorable functional outcomes in patients experiencing their first ischemic stroke due to AF.
• First-ever ischemic stroke in the studied cohort was more common in women.
• Effective prophylactic antithrombotic management remains critical for improving stroke outcomes in AF patients.