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Published on: February 26, 2013
First-Ever Stroke Outcomes in Patients with Atrial Fibrillation: A Retrospective Cross-Sectional Study
Ivanka Maduna1,2, Dorotea Vidaković3, Petra Črnac4
1Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia.
Insights
Patients with atrial fibrillation (AF) experiencing a first-ever ischemic stroke had better outcomes when treated with prior anticoagulant therapy, specifically warfarin, compared to antiplatelet therapy or no antithrombotic treatment.
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.
Abstract:
Background/Objectives: Atrial fibrillation (AF) is the most significant modifying risk factor for the development of cardioembolic stroke, which is associated with worse outcomes and higher intrahospital mortality compared to other types of ischemic stroke. Antithrombotic medications are administered as prophylactic treatment in patients with a risk of stroke. The aim of this study was to determine outcome measures in patients with first-ever ischemic stroke and AF regarding prior antithrombotic therapy. Methods: We collected data on stroke risk factors, CHADS2 score, and international normalized ratio (INR) value in the context of warfarin therapy, as well as data related to localization, stroke severity, and functional outcome at discharge. Results: A total of 754 subjects with first-ever ischemic stroke and AF were included in this cross-sectional study (122 on warfarin, 210 on acetylsalicylic acid, and 422 without prior antithrombotic therapy). The diagnosis of AF was previously unknown in 31% of the subjects. Stroke risk factors (arterial hypertension, hyperlipidemia, diabetes mellitus, and cardiomyopathy) were significantly lower in the group without prior antithrombotic therapy. The anticoagulant group was significantly younger (p = 0.001). Overall, 45.4% of subjects with a previously known AF event and a high risk of developing stroke received anticoagulant therapy. Participants on warfarin had a significantly better functional outcome than those on antiplatelet therapy or without prior antithrombotic therapy (median mRS 4 vs. 5 vs. 5; p = 0.025) and lower NIHSS scores, although the difference was not statistically significant (median 10 vs. 12 vs. 12; p = 0.09). There was no difference between stroke localization among groups (p = 0.116). Conclusions: Our study showed that, in our cohort, first-ever ischemic stroke due to AF was more common in women. Subjects on prior anticoagulant therapy had more favorable outcomes at discharge.
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