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Timing of oral anticoagulation in atrial fibrillation patients after acute ischaemic stroke and outcome after 3 months: results of the multicentre Berlin Atrial Fibrillation Registry.
Olma, Manuel C; Tütüncü, Serdar; Hansen, Katrin; Grittner, Ulrike; Kunze, Claudia; Dietzel, Joanna; Schurig, Johannes; Dimitrijeski, Boris; Hagemann, Georg; Hamilton, Frank; Honermann, Martin; Jungehuelsing, Gerhard Jan; Kauert, Andreas; Koennecke, Hans-Christian; Mackert, Bruno-Marcel; Nabavi, Darius G; Schmehl, Ingo; Sparenberg, Paul; Stingele, Robert; Voelzke, Enrico; Waldschmidt, Carolin; Zeise-Wehry, Daniel; Heuschmann, Peter U; Endres, Matthias; Haeusler, Karl Georg.
Afiliación
  • Olma MC; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Tütüncü S; Charité - Universitatsmedizin Berlin, Berlin, Germany.
  • Hansen K; Charité - Universitatsmedizin Berlin, Berlin, Germany.
  • Grittner U; Charité - Universitatsmedizin Berlin, Berlin, Germany.
  • Kunze C; Charité - Universitatsmedizin Berlin, Berlin, Germany.
  • Dietzel J; Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Schurig J; Department of Radiology and Neuroradiology, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany.
  • Dimitrijeski B; Vivantes Klinikum Neukölln, Berlin, Germany.
  • Hagemann G; HELIOS Klinikum Berlin-Buch, Berlin, Germany.
  • Hamilton F; Vivantes Auguste Viktoria Klinikum, Berlin, Germany.
  • Honermann M; Vivantes Klinikum Spandau, Berlin, Germany.
  • Jungehuelsing GJ; Jüdisches Krankenhaus Berlin, Berlin, Germany.
  • Kauert A; Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany.
  • Koennecke HC; Vivantes Klinikum im Friedrichshain, Berlin, Germany.
  • Mackert BM; Vivantes Auguste Viktoria Klinikum, Berlin, Germany.
  • Nabavi DG; Vivantes Klinikum Neukölln, Berlin, Germany.
  • Schmehl I; BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany.
  • Sparenberg P; BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany.
  • Stingele R; German Red Cross Hospital Berlin Kopenick, Berlin, Germany.
  • Voelzke E; Schlosspark-Klinik GmbH, Berlin, Germany.
  • Waldschmidt C; Medical Park AG, Amerang, Germany.
  • Zeise-Wehry D; HELIOS Klinikum Berlin-Buch, Berlin, Germany.
  • Heuschmann PU; Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
  • Endres M; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.
  • Haeusler KG; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Open Heart ; 11(2)2024 Sep 18.
Article en En | MEDLINE | ID: mdl-39299734
ABSTRACT

BACKGROUND:

Oral anticoagulation (OAC) is key in stroke prevention in patients with atrial fibrillation (AF) but there is uncertainty regarding the optimal timing of OAC (re)initiation after stroke, as recent large randomised controlled trials have methodological weaknesses and excluded stroke patients on therapeutic anticoagulation at stroke onset as well as patients started on a vitamin K antagonist after stroke. The '1-3-6-12 days rule', based on expert consensus and referring to stroke severity, was used in clinical practice to initiate OAC after acute ischaemic stroke or transient ischaemic attack (TIA) since publication in 2013.

METHODS:

We retrospectively assessed whether compliance to the '1-3-6-12 days rule' was associated with the composite endpoint (recurrent stroke, systemic embolism, myocardial infarction, major bleeding or all-cause death).

RESULTS:

Among 708 registry patients with known AF before stroke and hospitalisation within 72 hours after stroke, 432 were anticoagulated at stroke onset. OAC was started according to the '1-3-6-12 days rule' in 255 (39.2%) patients. Non-adherence to the '1-3-6-12 days rule' was not associated with the composite endpoint within 3 months in 661 patients who (re-)started on OAC (log-rank test p=0.74).Results were similar for 521 patients (re)started on a non-vitamin K-dependent OAC.

CONCLUSION:

(Re)starting OAC after stroke followed the '1-3-6-12 days rule' in about 40% of all patients with AF, and more often in those anticoagulated at stroke onset. Adherence to the '1-3-6-12 days rule' did not reduce the composite clinical endpoint, if OAC was restarted within 3 months of stroke/TIA. TRIAL REGISTRATION NUMBER NCT02306824.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Sistema de Registros / Accidente Cerebrovascular Isquémico / Anticoagulantes Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Sistema de Registros / Accidente Cerebrovascular Isquémico / Anticoagulantes Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido