Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation

Xian, Ying; O’Brien, Emily C.; Li, Liang; Xu, Haolin; Schwamm, Lee H; Fonarow, Gregg C.; Bhatt, Deepak L.; Smith, Eric E.; Olson, DaiWai M.; Maisch, Lesley; Hannah, Deidre; Lindholm, Brianna; Lytle, Barbara L.; Pencina, Michael J.; Hernandez, Adrian F.; Peterson, Eric D.

doi:10.1001/jama.2017.1371

Cited by 193 publications

(153 citation statements)

References 36 publications

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“…The underutilisation of OAC is a substantial public health issue . While it is difficult to assess the extent of adverse events accurately due to this issue, the number of patients presenting to hospital with a stroke and AF while not anticoagulated is well described . It is, therefore, of paramount importance to identify why OAC is underutilised, including whether availability of specialised clinics is a factor.…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Kennedy

Choitir

Clarke

et al. 2020

Brit J Clinical Pharma

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Oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation is underutilised. One of the impediments to warfarin therapy is the frequent monitoring required, usually at a specialised warfarin clinic. The advent of direct oral anticoagulants (DOACs) facilitates OAC therapy without an onerous monitoring regimen. This benefit may result in the more significant adoption of DOACs in areas without a warfarin clinic. This study analysed national administrative data for reimbursed pharmacy claims to assess OAC prescribing from 2010 to 2017 and compared the use of DOACs in areas with warfarin clinics compared to those without. Over the study period, the number of patients on OAC increased by 84%, due to a rapid increase in DOAC prescribing. The findings demonstrate that DOACs have resulted in an increase in the overall uptake of OAC therapy in Ireland. However, the increased utilisation was not evidently related to populations underserved by warfarin clinics.

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Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Kennedy

Choitir

Clarke

et al. 2020

Brit J Clinical Pharma

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“…A retrospective study of more than 90,000 patients with acute ischemic stroke and prior atrial fibrillation determined that 30% were not on antithrombotic therapy, and ~40% received an anti-platelet agent only [189]. Two-thirds had no documented reason as to why anticoagulation was withheld, but for those with a documented reason, bleeding (16%) and falls (10%) were cited most often.…”

Section: Future Directionsmentioning

confidence: 99%

Plasma contact factors as therapeutic targets

et al. 2018

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Direct oral anticoagulants (DOACs) are small molecule inhibitors of the coagulation proteases thrombin and factor Xa that demonstrate comparable efficacy to warfarin for several common indications, while causing less serious bleeding. However, because their targets are required for the normal host-response to bleeding (hemostasis), DOACs are associated with therapy-induced bleeding that limits their use in certain patient populations and clinical situations. The plasma contact factors (factor XII, factor XI, and prekallikrein) initiate blood coagulation in the activated partial thromboplastin time assay. While serving limited roles in hemostasis, pre-clinical and epidemiologic data indicate that these proteins contribute to pathologic coagulation. It is anticipated that drugs targeting the contact factors will reduce risk of thrombosis with minimal impact on hemostasis. Here, we discuss the biochemistry of contact activation, the contributions of contact factors in thrombosis, and novel antithrombotic agents targeting contact factors that are undergoing pre-clinical and early clinical testing.

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“…However, oral anticoagulants are especially underused in patients with known nonvalvular AF in China (Wang et al, ). Several studies have demonstrated that preceding oral anticoagulants are associated with reduced initial stroke severity on admission and reduced disability or death at discharge in IS patients with AF (O'Donnell et al, ; Xian et al, ). These results were consistent with our study.…”

Section: Discussionmentioning

confidence: 99%

Matrix metalloproteinase‐9 gene polymorphisms are associated with ischemic stroke severity and early neurologic deterioration in patients with atrial fibrillation

Zhou

Sui³

et al. 2019

Brain and Behavior

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Objectives The mechanisms of ischemic stroke severity and early neurologic deterioration (END) are not fully understood. The aim of the present study was to investigate the association of six variants in MMP‐9 gene with ischemic stroke severity and the risk for END in ischemic stroke (IS) patients with atrial fibrillation (AF). Methods This was a multi‐center, prospective, observational study of 615 acute IS patients with AF admitted to six participating hospitals between June 2016 and October 2017. Ischemic stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score on admission. END was defined as an increase of four or more points in NIHSS within 10 days of admission. Six variants of MMP‐9 gene were examined using mass spectrometry. Results Among the 615 enrolled patients, 112 (18.2%) patients presented with moderate or severe stroke (NIHSS score ≥16), and 108 (17.6%) patients suffered from END within 10 days of admission. Multiple logistic analysis showed that prestroke antiplatelet therapy, prestroke anticoagulant therapy, rs3918242 CT/TT, and rs3787268 AG/GG were independent predictors for stroke severity. Cox proportional hazard regression revealed that diabetes mellitus, prestroke antiplatelet therapy, prestroke anticoagulant therapy, rs1056628 AC/CC, and rs3918242 CT/TT were independently associated with the risk of END. Conclusions The incidence of moderate or severe stroke and END was very common in acute IS patients with AF. MMP‐9 polymorphisms were independently associated with severe stroke and higher risk of END, and prestroke antithrombotic treatment was associated with less severe stroke and lower risk of END in patients with AF.

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Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation

Abstract: Among patients with atrial fibrillation who had experienced an acute ischemic stroke, inadequate therapeutic anticoagulation preceding the stroke was prevalent. Therapeutic anticoagulation was associated with lower odds of moderate or severe stroke and lower odds of in-hospital mortality.

Cited by 193 publications

References 36 publications

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Plasma contact factors as therapeutic targets

Matrix metalloproteinase‐9 gene polymorphisms are associated with ischemic stroke severity and early neurologic deterioration in patients with atrial fibrillation

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