Antithrombotic Treatment at Onset of Stroke with Atrial Fibrillation, Functional Outcome, and Fatality: A Systematic Review and Meta-Analysis

Hannon, Niamh; Arsava, Ethem Murat; Audebert, Heinrich J.; Ay, Hakan; Crowe, Morgan; Chróinín, Danielle Ní; Furie, Karen L.; McGorrian, Catherine; Molshatzki, Noa; Murphy, Seán; Noone, Imelda; O’Donnell, Martin; Schenkel, Johannes; Tan, Kit Mun; Tanné, David; Kelly, Peter

doi:10.1111/ijs.12473

Cited by 20 publications

(11 citation statements)

References 32 publications

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“…Typically, stroke-related hospital data collection ends 90 days after discharge, limiting a more comprehensive assessment of recovery. 23,24 Documentation of longitudinal stroke outcomes and factors associated with long-term stroke prognosis is an important consideration when seeking to understand factors emerging after hospitalization that impact stroke recovery in specific populations. The Health and Retirement Study (HRS) is a longitudinal dataset with unique epidemiological variables that may be important in understanding stroke recovery disparities.…”

Section: Racial Disparities In Stroke Recovery Persistence In the Posmentioning

confidence: 99%

Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

et al. 2020

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Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retirement Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily living (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were younger compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comorbidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of having increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.Ethn Dis. 2020;30(2):339-348; doi:10.18865/ ed.30.2.339

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Section: Racial Disparities In Stroke Recovery Persistence In the Posmentioning

confidence: 99%

Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

et al. 2020

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“…Although not being very consistent, inadequate adherence to warfarin has shown to be associated with poor anticoagulation control [international normalized ratio (INR) out of targeted therapeutic range] (8,9). Maintaining INR in the targeted therapeutic range (2.0-3.0) increases the improvement in functional outcomes by 2-fold, it reduces the risk of death after stroke by 2.8-fold (1,10). An INR value below the targeted limit increases the risk of recurrent venous thromboembolism or stroke, whereas values over the limit may lead to hemorrhagic events that result in excessive bleeding or death.…”

Section: Introductionmentioning

confidence: 99%

“…An INR value below the targeted limit increases the risk of recurrent venous thromboembolism or stroke, whereas values over the limit may lead to hemorrhagic events that result in excessive bleeding or death. Therefore, optimal management of the treatment includes a correctly prescribed dose regimen that avoids the risk of both thromboembolism and bleeds, and monitoring of the INR value and enhancing patient adherence (10,11,12).…”

Section: Introductionmentioning

confidence: 99%

Determination of Factors that Impact Adherence to Warfarin in Patients with Stroke

Tülek¹,

Dünya²,

Çiftçioğlu³

et al. 2019

tnd

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Objective: Oral anticoagulants are the mainstay in the secondary prevention of stroke. Adherence to drug is an important issue in preventing stroke. The aim of this study was to determine the adherence of patients with stroke to warfarin (anticoagulant agent) and to investigate the factors that may impact adherence. Materials and Methods: This descriptive cross-sectional study was conducted on patients admitted to an outpatient neurology clinic of a tertiary hospital in Istanbul. A total of 99 patients with stroke who were under warfarin treatment for at least 6 months prior to the study were enrolled in the study. Patients were assessed in terms of sociodemographic characteristics, adherence to and knowledge regarding the drug, anxiety and depression, mental and functional state and quality of life using validated scales. Results: The mean adherence score of the patients was 3.3±1.1 (0-4). The reported adherence rates were not considered as low in our sample given that 42% had poor knowledge. Significant negative correlations were determined between drug adherence and age, number of risk factors, and duration of anticoagulant use (r=-0.39, r=-0.33, r=-0.52, p<0.001, respectively). The mean drug adherence scores were lower in patients who had experienced drug-related adverse effects compared with those that did not (p=0.018). Significant correlations were found between the adherence scale and all other variables (p<0.05). Multiple linear regression analysis revealed that drug adherence was predicted by experiencing adverse effects, knowledge regarding the drug, and depression. Conclusion: Knowledge regarding the use of warfarin was inadequate in our patients, whereas adherence was reported not to be inadequate. The most influential factors that may impact adherence were adverse effects, knowledge, and depression. Healthcare professionals should be aware of patients who have risk factors for non-adherence.

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“… 11 In addition to the reduction of stroke risk, the intake of VKA reduces stroke severity and improves long-term outcome if the international normalized ratio (INR) is within therapeutic range at stroke onset. 8 , 12 One could argue that there might be a similar effect of pre-admission NOAC intake on stroke-related morbidity and mortality but there is—besides a retrospective analysis including nine patients with NOAC intake before ischaemic stroke—no published analysis so far. 13 , 14 Interestingly, recently published experimental data showed a beneficial effect of rivaroxaban pre-treatment on stroke severity in rats.…”

Section: Introductionmentioning

confidence: 99%

Non-vitamin K-dependent oral anticoagulants have a positive impact on ischaemic stroke severity in patients with atrial fibrillation

et al. 2017

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AimsSeveral studies showed reduced stroke severity in patients with atrial fibrillation (AF) if the international normalized ratio (INR) was ≥ 2 at stroke onset. There are no respective data for non-vitamin K-dependent oral anticoagulants (NOACs). The aim of this study was to compare the impact of NOAC or phenprocoumon intake on stroke severity.Methods and resultsIn this single-centre observational study, 3669 patients with acute ischaemic stroke were retrospectively analysed regarding AF status and medication immediately before admission. Using multivariable regression, we analysed the association of pre-admission anticoagulation with severe stroke (National Institutes of Health Stroke Scale score ≥ 11) on admission and poor outcome at discharge (modified Rankin scale score > 2). Before the index stroke, 655 patients had known AF and a CHA2DS2-VASc score ≥ 2. While 325 (49.6%) patients were anticoagulated, 159 (24.3%) were prescribed a NOAC and 75 (11.5%) phenprocoumon patients had an INR ≥ 2 on admission. Compared with AF patients without medical stroke prevention, an INR ≥ 2 [OR 0.23 (95% CI 0.10–0.53)] or NOAC intake [OR 0.48 (95% CI 0.27–0.86)] were associated with a lower probability of severe stroke after adjustment for confounders, while an INR < 2 [OR 0.62 (95% CI 0.33–1.16)] was not. Adjusted odds ratios for poor functional outcome at hospital discharge were 0.47 (95% CI 0.27–0.84) for NOAC patients, 0.33 (95% CI 0.17–0.65) for INR ≥ 2 and 0.61 (95% CI 0.32–1.16) for INR < 2.ConclusionNOAC intake before stroke did reduce the probability of severe stroke on hospital admission and poor functional outcome at hospital discharge as similarly demonstrated for phenprocoumon patients with an INR ≥ 2 on admission.

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Antithrombotic Treatment at Onset of Stroke with Atrial Fibrillation, Functional Outcome, and Fatality: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 32 publications

Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

Determination of Factors that Impact Adherence to Warfarin in Patients with Stroke

Non-vitamin K-dependent oral anticoagulants have a positive impact on ischaemic stroke severity in patients with atrial fibrillation

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