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. 2020 Dec;5(4):374-383.
doi: 10.1177/2396987320937116. Epub 2020 Jul 22.

Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes

Maurizio Paciaroni  1 , Giancarlo Agnelli  1 , Michela Giustozzi  1 , Georgios Tsivgoulis  2   3 , Shadi Yaghi  4 , Brian Mac Grory  4 , Karen L Furie  4 , Prasanna Tadi  4 , Marialuisa Zedde  5 , Azmil H Abdul-Rahim  6 , Jesse Dawson  6 , Kennedy R Lees  6 , Andrea Alberti  1 , Michele Venti  1 , Monica Acciarresi  1 , Cataldo D'Amore  1 , Maria Giulia Mosconi  1 , Valentina Bogini  1 , Manuel Cappellari  7 , Alberto Rigatelli  8 , Bruno Bonetti  7 , Jukka Putaala  9 , Liisa Tomppo  9 , Turgut Tatlisumak  10   11 , Fabio Bandini  12 , Simona Marcheselli  13 , Alessandro Pezzini  14 , Loris Poli  14 , Alessandro Padovani  14 , Luca Masotti  15 , Elisa Grifoni  15 , Vieri Vannucchi  15 , Sung-Il Sohn  16 , Gianni Lorenzini  17 , Rossana Tassi  18 , Francesca Guideri  18 , Maurizio Acampa  18 , Giuseppe Martini  18 , George Ntaios  19 , George Athanasakis  19 , Konstantinos Makaritsis  19 , Efstathia Karagkiozi  19 , Konstantinos Vadikolias  20 , Chrissoula Liantinioti  3 , Lina Palaiodimou  3 , Nicola Mumoli  21 , Cesare Porta  21 , Franco Galati  22 , Simona Sacco  23 , Cindy Tiseo  23 , Francesco Corea  24 , Walter Ageno  25 , Marta Bellesini  25 , Giorgio Silvestrelli  26 , Alfonso Ciccone  26 , Umberto Scoditti  27 , Licia Denti  28 , Michelangelo Mancuso  29 , Maria C Caselli  29 , Miriam Maccarrone  29 , Leonardo Ulivi  29 , Giovanni Orlandi  29   30 , Nicola Giannini  29 , Tiziana Tassinari  31 , Maria L De Lodovici  32 , Christina Rueckert  33 , Antonio Baldi  34 , Danilo Toni  35 , Luana Gentile  35 , Federica Letteri  35 , Martina Giuntini  30 , Enrico M Lotti  36 , Yuriy Flomin  37 , Alessio Pieroni  35 , Odysseas Kargiotis  38 , Theodore Karapanayiotides  39 , Serena Monaco  40 , Marina Mannino  40 , Mario M Baronello  40 , Laszló Csiba  41 , Lilla Szabó  41 , Alberto Chiti  29   30   42 , Elisa Giorli  42 , Massimo Del Sette  42   43 , Erika Schirinzi  43 , Davide Imberti  44 , Dorjan Zabzuni  44 , Boris Doronin  45 , Vera Volodina  45 , Patrik Michel  46 , Ashraf Eskandari  46 , Peter Vanacker  47 , Kristian Barlinn  48 , Jessica Barlinn  48 , Dirk Deleu  49 , Vanessa Gourbali  50 , Valeria Caso  1
Affiliations

Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes

Maurizio Paciaroni et al. Eur Stroke J. 2020 Dec.

Abstract

Introduction: The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing.

Materials and methods: Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of stroke recurrence, transient ischaemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke.

Results: A total of 2470 patients were available for the analysis: 473 (19.1%) with PS and 1997 (80.9%) with AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39-2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16-1.80).

Discussion: our findings suggest that, when deciding the time to initiate oral anticoagulation, the location of stroke, either anterior or posterior, does not predict the risk of outcome events.

Conclusions: Patients with PS or AS and AF appear to have similar risks of ischaemic or haemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT.

Keywords: Acute stroke; atrial fibrillation; stroke recurrence.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier curves of outcome events stratified by timing of initiation of oral anticoagulants in patients with anterior or posterior stroke.
Figure 2.
Figure 2.
Kaplan–Meier curves of outcome events in patients with posterior stroke stratified by lesion size.
See this image and copyright information in PMC

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