@article{3108073,
    title = "Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study",
    author = "Paciaroni, M. and Agnelli, G. and Falocci, N. and Tsivgoulis, G. and Vadikolias, K. and Liantinioti, C. and Chondrogianni, M. and Bovi, P. and Carletti, M. and Cappellari, M. and Zedde, M. and Ntaios, G. and Karagkiozi, E. and Athanasakis, G. and Makaritsis, K. and Silvestrelli, G. and Lanari, A. and Ciccone, A. and Putaala, J. and Tomppo, L. and Tatlisumak, T. and Abdul-Rahim, A.H. and Lees, K.R. and Alberti, A. and Venti, M. and Acciarresi, M. and D'Amore, C. and Becattini, C. and Mosconi, M.G. and Cimini, L.A. and Soloperto, R. and Masotti, L. and Vannucchi, V. and Lorenzini, G. and Tassi, R. and Guideri, F. and Acampa, M. and Martini, G. and Sohn, S.-I. and Marcheselli, S. and Mumoli, N. and De Lodovici, M.L. and Bono, G. and Furie, K.L. and Tadi, P. and Yaghi, S. and Toni, D. and Letteri, F. and Tassinari, T. and Kargiotis, O. and Lotti, E.M. and Flomin, Y. and Mancuso, M. and Maccarrone, M. and Giannini, N. and Bandini, F. and Pezzini, A. and Poli, L. and Padovani, A. and Scoditti, U. and Denti, L. and Consoli, D. and Galati, F. and Sacco, S. and Carolei, A. and Tiseo, C. and Gourbali, V. and Orlandi, G. and Giuntini, M. and Chiti, A. and Giorli, E. and Gialdini, G. and Corea, F. and Ageno, W. and Bellesini, M. and Colombo, G. and Monaco, S. and Baronello, M.M. and Karapanayiotides, T. and Caso, V.",
    journal = "Journal of the American Heart Association",
    year = "2017",
    volume = "6",
    number = "12",
    publisher = "American Heart Association Inc.",
    issn = "2047-9980",
    doi = "10.1161/JAHA.117.007034",
    keywords = "apixaban;  dabigatran;  rivaroxaban;  anticoagulant agent;  apixaban;  dabigatran;  pyrazole derivative;  pyridone derivative;  rivaroxaban;  vitamin K group, aged;  Article;  atrial fibrillation;  brain hemorrhage;  brain ischemia;  controlled clinical trial;  controlled study;  female;  hospital admission;  human;  kidney function;  major clinical study;  male;  multicenter study;  observational study;  priority journal;  prospective study;  recurrent disease;  secondary prevention;  acute disease;  antagonists and inhibitors;  atrial fibrillation;  bleeding;  brain ischemia;  chemically induced;  complication;  dose response;  follow up;  incidence;  middle aged;  oral drug administration;  recurrent disease;  survival rate;  time factor;  treatment outcome;  trends;  very elderly, Acute Disease;  Administration, Oral;  Aged;  Aged, 80 and over;  Anticoagulants;  Atrial Fibrillation;  Brain Ischemia;  Dabigatran;  Dose-Response Relationship, Drug;  Female;  Follow-Up Studies;  Hemorrhage;  Humans;  Incidence;  Male;  Middle Aged;  Prospective Studies;  Pyrazoles;  Pyridones;  Recurrence;  Rivaroxaban;  Survival Rate;  Time Factors;  Treatment Outcome;  Vitamin K",
    abstract = "Background--The optimal timing to administer non-vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within90 days)and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOACs for secondary prevention. Methods and Results--Recurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA2DS2-VASc score > 4 and less reduced renal function. Thirty-two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOACs within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated > 14 days after acute stroke. Conclusions--In patients with acute ischemic stroke and atrial fibrillation, treatment with NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days. © 2017 The Authors."
}