Is Anticoagulation Necessary for Severely Disabled Cardioembolic Stroke Survivors?

Jurjāns, Kristaps; Vikmane, Baiba; Vētra, Jānis; Miglāne, Evija; Kalējs, Oskars; Priede, Zanda; Millers, Andrejs

doi:10.3390/medicina55090586

Cited by 3 publications

(7 citation statements)

References 36 publications

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“…The prevalence of AF among AIS patients varies between countries and was found to be as high as 31-38% in a population-based registry in Greece [31,32], and up to 48.6% in two separate hospital-based registries in neighboring Latvia [22,24]. The high prevalence of AF found in our investigated AIS patient population could indicate a regional trend, as other cardiovascular risk factors are largely similar within the Baltic States [32].…”

Section: Discussionmentioning

confidence: 89%

“…Moreover, in Lithuania the expected increase in age-adjusted stroke incidence and prevalence rates is the highest, and the expected decrease in stroke mortality is the lowest among all European Union countries [21]. However, data regarding the proportion of AIS cases associated with AF is lacking, although studies from the other two Baltic States indicate some of the highest AF prevalence among AIS patients globally, reaching up to a striking 48.6% [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

et al. 2022

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Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

et al. 2022

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“…Our study consisted of the systematically collected data, as well as multiple follow-ups conducted via telephone, of 654 patients who were treated at our hospital’s Stroke Unit in the year 2017. The ischemic stroke incidence in Latvia is 131–150 per 100,000 people [ 1 ] and our center is only one of the seven available stroke units in Latvia [ 8 ]; therefore, the data of the patients does not represent the entire stroke population in our country [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Satisfactory functional outcome after 90 days (defined as mRS 0–2) reached 46% in the atherothrombotic ischemic stroke patient group and only in 35% of all cardioembolic ischemic stroke survivors [ 17 ]. Jurjans et al stated that in patients receiving antiplatelet agents, only 3.0% of patients reached satisfactory functional outcomes (mRS 0–2) in 5 years, compared to 30.5% in patients receiving direct oral anticoagulants [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is also an increased risk in patients with atrial fibrillation for a large vessel occlusion with a following more severe neurological impairment; hence a significantly poorer self-perceived Health-Related Quality of Life (HRQoL) at 90 days as presented in a study by Masiliūnas (2022) [ 7 ]. The recurrence of a cardioembolic stroke can be prevented by regularly taking oral anticoagulants [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients

et al. 2022

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Background and Objectives: Stroke is currently the second most common cause of death and disability-adjusted life years worldwide. Previous studies have determined that cardioembolic stroke is associated with higher mortality. Our aim is to compare the long-term outcome and mortality of atherothrombotic, cardioembolic stroke patients and patients taking direct oral anticoagulants (DOACs), and to demonstrate that adequate treatment with DOACs is associated with better results. Materials and Methods: In our retrospective study, we collected the data of ischemic stroke patients who were treated at P. Stradins Clinical University Hospital, Riga, Latvia, Stroke Unit, in the year 2017. In the present study, we analyzed this information to assess the patients’ demographic and clinical data, vascular risk factors, functional and neurological evaluation results, and the use of anticoagulant therapy. Stroke survivors were followed-up via telephone at 30/90/180/365 days and 4 years after being discharged from the hospital. The Latvian version of the National Institutes of Health Stroke Scale (NIHSS-LV) was used to evaluate patients’ neurological outcomes at discharge, and patients’ functional outcomes were evaluated using the modified Rankin scale (mRS). The collected data of the patients were separated into three groups according to the stroke subtype and use of direct oral anticoagulants. Results: A total of 654 ischemic stroke patients were admitted to the hospital in the year 2017. Of all the strokes included in the study, 262 presented an atherothrombotic etiology and 392 presented a cardioembolic etiology. The median age of the patients in the study was 76 years (IQR: 67–83). The median age of patients in the atherothrombotic stroke group was 71 years (IQR = 64–79), in the cardioembolic stroke group it was 79 (IQR = 72–84), and in the DOAC group it was 75 years (IQR = 69–82), respectively. At the period of four years, of all the atherothrombotic stroke survivors 14 (10.5%) had a severe disability, and 64 (48.1%) did not survive. However, 12 (4.1%) of the cardioembolic stroke survivors were severely disabled and 37 (12.5%) had died. In the group of patients taking DOACs 6 (4.5%) had a severe disability and 17 (12.9%) did not survive. In all the patient groups, the leading cause of death was due to severe disability (22%), followed by recurrent cardioembolic events (8%). Conclusions: Previous studies until now have concluded that cardioembolic stroke is associated with higher mortality and an unfavorable functional outcome. In our study, the cardioembolic stroke group and the DOAC group had a statistically significant higher percentage of patients with congestive heart failure and older age, but their long-term mortality was lower and they achieved independence more often than the atherothrombotic stroke patients. The proper use of anticoagulants shows great improvement in long-term survival rate and functional outcome.

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Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta‐analysis

et al. 2022

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Objectives We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. Methods We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle–Ottawa scale. Where possible, data were pooled using random‐effects meta‐analysis. Results We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%–68%), and 68% (95% CI: 58%–79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%–93%). It was reported that 11% (95% CI: 2%–19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%–89%), 71% (95% CI: 57%–84%), and 73% (95% CI: 59%–86%), respectively. Conclusion In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.

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Is Anticoagulation Necessary for Severely Disabled Cardioembolic Stroke Survivors?

Cited by 3 publications

References 36 publications

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients

Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta‐analysis

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