TY - JOUR
TI - Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study
AU - Paciaroni, M.
AU - Agnelli, G.
AU - Falocci, N.
AU - Tsivgoulis, G.
AU - Vadikolias, K.
AU - Liantinioti, C.
AU - Chondrogianni, M.
AU - Bovi, P.
AU - Carletti, M.
AU - Cappellari, M.
AU - Zedde, M.
AU - Ntaios, G.
AU - Karagkiozi, E.
AU - Athanasakis, G.
AU - Makaritsis, K.
AU - Silvestrelli, G.
AU - Lanari, A.
AU - Ciccone, A.
AU - Putaala, J.
AU - Tomppo, L.
AU - Tatlisumak, T.
AU - Abdul-Rahim, A.H.
AU - Lees, K.R.
AU - Alberti, A.
AU - Venti, M.
AU - Acciarresi, M.
AU - D'Amore, C.
AU - Becattini, C.
AU - Mosconi, M.G.
AU - Cimini, L.A.
AU - Soloperto, R.
AU - Masotti, L.
AU - Vannucchi, V.
AU - Lorenzini, G.
AU - Tassi, R.
AU - Guideri, F.
AU - Acampa, M.
AU - Martini, G.
AU - Sohn, S.-I.
AU - Marcheselli, S.
AU - Mumoli, N.
AU - De Lodovici, M.L.
AU - Bono, G.
AU - Furie, K.L.
AU - Tadi, P.
AU - Yaghi, S.
AU - Toni, D.
AU - Letteri, F.
AU - Tassinari, T.
AU - Kargiotis, O.
AU - Lotti, E.M.
AU - Flomin, Y.
AU - Mancuso, M.
AU - Maccarrone, M.
AU - Giannini, N.
AU - Bandini, F.
AU - Pezzini, A.
AU - Poli, L.
AU - Padovani, A.
AU - Scoditti, U.
AU - Denti, L.
AU - Consoli, D.
AU - Galati, F.
AU - Sacco, S.
AU - Carolei, A.
AU - Tiseo, C.
AU - Gourbali, V.
AU - Orlandi, G.
AU - Giuntini, M.
AU - Chiti, A.
AU - Giorli, E.
AU - Gialdini, G.
AU - Corea, F.
AU - Ageno, W.
AU - Bellesini, M.
AU - Colombo, G.
AU - Monaco, S.
AU - Baronello, M.M.
AU - Karapanayiotides, T.
AU - Caso, V.
JO - Journal of the American Heart Association
PY - 2017
VL - 6
TODO - 12
SP - null
PB - American Heart Association Inc.
SN - 2047-9980
TODO - 10.1161/JAHA.117.007034
TODO - 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
TODO - 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.
ER -