Anticoagulation Therapy Reduces Recurrent Stroke in Embolic Stroke of Undetermined Source Patients With Elevated Coagulation Markers or Severe Left Atrial Enlargement

Patel, Kishan; Mikhael, Elio; Liu, Mengmeng; Rangaraju, Srikant; Ellis, Deandra; Duncan, Alexander; Belagaje, Samir; Belair, Trina; Henríquez, Laura; Nahab, Fadi

doi:10.3389/fneur.2021.695378

Cited by 8 publications

(4 citation statements)

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“…32 In another observation study, ESUS patients with severe LAE showed bene t from anticoagulation treatment. 33 The results of ongoing trials focusing on the effect of anticoagulation in ESUS patients with left atrial cardiopathy may therefore be of interest. In addition, speci c lesion patterns may also be considered in future clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source

Bae,

Ryu,

et al. 2024

Preprint

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Background Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up. Methods Patients with acute ischemic stroke classified as ESUS were included. All patients underwent transthoracic echocardiography and Holter to detect the source of embolism. Structural, electrophysiological markers of left atrial cardiopathy (i.e., left atrial enlargement [LAE], non-sustained tachycardia [NSAT]) as well as lesion patterns of ischemic stroke were examined. Implantable loop recorder (ILR) was implanted in selective patients. Sensitivity and positive predictive value analysis was used to assess the predictive value for AF detection. Results Among 312 patients with ESUS, AF was detected in 24 (7.7%) patients during follow-up. Patients with AF had a higher prevalence of LAE, NSAT, and the imaging pattern of confluent plus additional lesions in a single vascular territory. Multivariable analysis showed that ILR implantation (hazards ratio 11.497 [95% confidence interval 3.795–34.818]), LAE (3.204 [1.096–9.370]), NSAT (4.070 [1.378–12.018]), and confluent plus additional lesions (4.977 [1.649–15.019]) were independent predictors of AF detection. The sensitivity of detecting AF in those with LAE, NSAT, or confluent plus additional lesions pattern was 91.7%. The positive predictive value of detecting AF in those with LAE, NSAT and confluent plus additional lesions pattern was 40.0%. Conclusion In conclusion, patients with LAE, NSAT, or confluent plus additional lesions may benefit from ILR monitoring detecting new AF.

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Section: Discussionmentioning

confidence: 99%

Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source

Bae,

Ryu,

et al. 2024

Preprint

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“…В исследовании WARSS в группе пациентов с NT-proBNP ≥ 750 пг/мл продемонстрированы преимущества варфарина над антитромбоцитарной терапией в виде снижения риска ИИ и смерти на 70% [53]. В недавнем небольшом ретроспективном исследовании показано, что назначение антикоагулянта в подгруппе пациентов с отклонением маркеров коагуляции и гемостаза или выраженным увеличением ЛП (ИОЛП ≥ 40 см/м 2 ) ассоциировано со снижением частоты повторного инсульта в сравнении с антитромбоцитарной терапией − 14% против 3% в течение года без повышения риска внутричерепных кровоизлияний [65]. Однако следует отметить, что атриомегалия имела место лишь у каждого десятого пациента, тогда как ведущим поводом к назначению антикоагулянтной терапии служило наличие маркеров гиперкоагуляции.…”

Section: шкалы риска фибрилляция предсердий у пациентов с инсультомunclassified

Cryptogenic stroke. Part 3: atrial cardiopathy and silent atrial fibrillation

et al. 2022

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Atrial cardiopathy (AC) and silent atrial fibrillation (AF) are potential causes of embolic cryptogenic stroke (embolic stroke of undetermined source, ESUS) timely diagnosis of which can significantly change the direction of secondary prevention and reduce the risk of repeated brain catastrophe. The article discusses clinical and radiological markers of cardioembolism, the concept of atrial cardiopathy, its electrocardiographic, echocardiographic and serum markers, as well as the possibility of drug prophylaxis of recurrent stroke. The most applicable AC features in daily operation are the ECG data (p-wave terminal force in lead V1 > 5000 μV x ms, supraventricular extrasystoles and advanced interatrial block), 24-hour ECG monitoring (≥ 480 supraventricular extrasystoles per 24-hour, paroxysms of supraventricular tachycardia ≥ 20 complexes), transthoracic (diameter of left atrium > 40 mm, index of diameter of left atrium ≥ 3 cm/m2, index of volume of left atrium > 34 ml/m2) and transesophageal echocardiography (spontaneous echo contrast phenomenon, blood flow rate in LA appendage <20 cm/s) and NT-proBNP concentration > 250 pg/ml. An individual, interdisciplinary decision to prescribe an anticoagulant when combined: (1) the presence of structural and functional AC markers, (2) cardioembolic pattern of a cerebral infarction or intracranial artery occlusion by visualization data and (3) high thromboembolic risk and probability of detection of AF on assessment scales (CHA2DS2-VASc, AF-ESUS and C2HEST). The greatest benefit of prescribing anticoagulant therapy can be obtained by patients with recurrent ESUS in whom sufficient secondary prevention and expressed AC, typical cardioembolism imaging pattern and high risk of thromboembolic events have already been achieved.

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“…В недавнем ретроспективном исследовании показано, что назначение ОАК в подгруппе пациентов с отклонением маркеров коагуляции и гемостаза или выраженным увеличением левого предсердия (индекс объема левого предсердия ≥40 см/м 2 ) ассоциировано со снижением часто-ты повторного инсульта в сравнении с антиагрегантной терапией -3% против 14% в течение года без повышения риска внутричерепных кровоизлияний [76].…”

Section: Characteristics Of Multicenter Observational Studies Focused On the Oacs Initiation After Isunclassified

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

Кулеш

2021

RJTAO

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The article evaluates recent perspectives about the role of oral anticoagulants in the secondary prevention of cardioembolic stroke. The timing of prescribing drugs for ischemic stroke and transient ischemic attack is discussed in accordance with current clinical guidelines and the results of clinical trials. The issues of prescribing oral anticoagulants in some problematic situations, such as the elderly and senile age, reperfusion therapy, presence of hemorrhagic transformation, combined atherosclerosis of major head and neck arteries, cerebral microangiopathy, history of intracerebral hemorrhage, cryptogenic stroke, and low patient compliance are considered. Finally, an anticoagulant therapy algorithm in the acute period of cardioembolic stroke is presented.

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Anticoagulation Therapy Reduces Recurrent Stroke in Embolic Stroke of Undetermined Source Patients With Elevated Coagulation Markers or Severe Left Atrial Enlargement

Cited by 8 publications

References 14 publications

Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source

Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source

Cryptogenic stroke. Part 3: atrial cardiopathy and silent atrial fibrillation

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

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