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1. Reperfusion therapies in patients with acute ischaemic stroke and atrial fibrillation: data on safety and effectiveness from a multi-centre cohort study

Author

Cancelloni, Virginia, Buratti, Mariachiara, Tsivgoulis, Georgios, Furie, Karen L., Tadi, Prasanna, Caso, Valeria, Becattini, Cecilia, Agnelli, Giancarlo, Zedde, Marialuisa, Abdul-Rahim, Azmil H., Alberti, Andrea, Venti, Michele, de Magistris, Ilaria Leone, Acciarresi, Monica, D’Amore, Cataldo, Mosconi, Maria G., Cimini, Ludovica A., Cappellari, Manuel, Putaala, Jukka, Tomppo, Liisa, Tatlisumak, Turgut, Bandini, Fabio, Marcheselli, Simona, Pezzini, Alessandro, Sohn, Sung-I. I., Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Ntaios, George, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Sagris, Dimitrios, Adamou, Anastasia, Vadikolias, Kostantinos, Palaiodimou, Lina, Chondrogianni, Maria, Mumoli, Nicola, Galati, Franco, Sacco, Simona, Tiseo, Cindy, Corea, Francesco, Ageno, Walter, Bellesini, Marta, Silvestrelli, Giorgio, Ciccone, Alfonso, Mancuso, Michelangelo, Orlandi, Giovanni, Pascarella, Rosario, Tassinari, Tiziana, Rueckert, Christina, Baldi, Antonio, Toni, Danilo, Lettieri, Federica, Giuntini, Martina, Lotti, Enrico M., Flomin, Yuriy, Pieroni, Alessio, Kargiotis, Odysseas, Karapanayiotides, Theodore, Halvatsiotis, Panagiotis, Monaco, Serena, Baronello, Mario M., Csiba, Laszlò, Szabò, Lilla, Chiti, Alberto, Giorli, Elisa, Del Sette, Massimo, Imberti, Davide, Zabzuni, Dorjan, Doronin, Boris, Volodina, Vera, Michel, Patrik, Vanacker, Peter, Barlinn, Kristian, Pallesen, Lars P., Kepplinger, Jessica, Deleu, Dirk, Gourbali, Vanessa, Yaghi, Shadi, and Paciaroni, Maurizio

Published
2024
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4. Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA

Author

Ishiguchi, Hironori, Huang, Bi, El-Bouri, Wahbi K., Dawson, Jesse, Lip, Gregory Y.H., Abdul-Rahim, Azmil H., Lees, K.R., Alexandrov, A., Bath, P.M., Bluhmki, E., Bornstein, N., Chen, C., Claesson, L., Curram, J., Davis, S.M., Diener, H-C., Donnan, G., Fisher, M., Ginsberg, M., Gregson, B., Grotta, J., Hacke, W., Hennerici, M.G., Hommel, M., Kaste, M., Lyden, P., Marler, J., Muir, K., Roffe, C., Sacco, R., Shuaib, A., Teal, P., Venketasubramanian, N., Wahlgren, N.G., and Warach, S.

Published
2024
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9. Improving economic evaluations in stroke: A report from the ESO Health Economics Working Group

Author

Cadilhac, Dominique A, Kim, Joosup, Wilson, Alastair, Berge, Eivind, Patel, Anita, Ali, Myzoon, Saver, Jeffrey, Christensen, Hanne, Cuche, Matthieu, Crews, Sean, Wu, Olivia, Provoyeur, Marine, McMeekin, Peter, Durand-Zaleski, Isabelle, Ford, Gary A, Muhlemann, Natalia, Bath, Philip M, Abdul-Rahim, Azmil H, Sunnerhagen, Katharina, Meretoja, Atte, Thijs, Vincent, Weimar, Christian, Massaro, Ayrton, Ranta, Annemarei, and Lees, Kennedy R

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Stroke, Good Health and Well Being, economic evaluation, health policy, health outcomes, modified Rankin Scale, EuroQol, ESO Health Economics Working group, Cardiovascular medicine and haematology, Epidemiology, Public health
Abstract

IntroductionApproaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke.MethodsThe ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies. A modified Delphi approach, including a survey and consensus processes, was used to agree on content. We also asked the participants about resources that could be shared to improve economic evaluations of interventions for stroke.ResultsOf 28 experts invited, 16 (57%) completed the initial survey, with representation from universities, government, and industry. More than half of the survey respondents endorsed 13 specific items to include in a standard resource use questionnaire. Preferred functional/quality of life outcome measures to use for economic evaluations were the modified Rankin Scale (14 respondents, 88%) and the EQ-5D instrument (11 respondents, 69%). Of the 12 respondents who had access to data used in economic evaluations, 10 (83%) indicated a willingness to share data. A protocol template and a guidance document for data collection were developed and are presented in this article.ConclusionThe protocol template and guidance document for data collection will support a more standardised and transparent approach for economic evaluations of stroke care.

Published
2020

11. Statin Therapy in Ischemic Stroke Patients with Atrial Fibrillation: Efficacy and Safety Outcomes

Author

Marvardi, Michele, primary, Ferrante, Mario, additional, Paciaroni, Maurizio, additional, Abdul-Rahim, Azmil H, additional, Tsivgoulis, Georgios, additional, Seiffge, David J, additional, Engelter, Stefan T, additional, Lyrer, Philippe A., additional, Polymeris, Alexandros A, additional, Dittrich, Tolga D, additional, Cancelloni, Virginia, additional, Zietz, Annaelle, additional, De Marchis, Gian Marco, additional, Putaala, Jukka, additional, Strbian, Daniel, additional, Tomppo, Liisa, additional, Michel, Patrik, additional, Strambo, Davide, additional, Salerno, Alexander, additional, Vanacker, Peter, additional, Zuurbier, Susanna M., additional, Yperzeele, Laetitia, additional, Loos, Caroline MJ, additional, Cappellari, Manuel, additional, Emiliani, Andrea, additional, Zedde, Marialuisa, additional, Becattini, Cecilia, additional, Pascarella, Rosario, additional, Dawson, Jesse, additional, Cronshaw, Robert, additional, Schirinzi, Erika, additional, Del Sette, Massimo, additional, Stretz, Christoph, additional, Kala, Narendra Sharma, additional, Schomer, Ashley, additional, Mac Grory, Brian, additional, Jayaraman, Mahesh V, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Masotti, Luca, additional, Grifoni, Elisa, additional, Toni, Danilo, additional, Risitano, Angela, additional, Falcou, Anne A, additional, Petraglia, Luca, additional, Lotti, Enrico Maria, additional, Pavolucci, Lucia, additional, Lochner, Piergiorgio, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Alberti, Andrea, additional, Venti, Michele, additional, Leone De Magistris, Ilaria, additional, Mosconi, Maria Giulia, additional, Giustozzi, Michela, additional, Kargiotis, Odysseas, additional, Rocco, Alessandro, additional, Diomedi, Marina, additional, Marcheselli, Simona, additional, Antonenko, Kateryna, additional, Rota, Eugenia, additional, Tassinari, Tiziana, additional, Saia, Valentina, additional, Palmerini, Francesco, additional, Aridon, Paolo, additional, Arnao, Valentina, additional, Monaco, Serena, additional, Cottone, Salvatore, additional, Baldi, Antonio, additional, D'Amore, Cataldo, additional, Ageno, Walter, additional, Pegoraro, Samuela, additional, Ntaios, George, additional, Adamou, Anastasia, additional, Sagris, Dimitrios, additional, Giannopoulos, Sotirios, additional, Kosmidou, Maria, additional, Ntais, Evangelos, additional, Romoli, Michele, additional, Pantoni, Leonardo, additional, Rosa, Silvia, additional, Bertora, Pierluigi, additional, Chiti, Alberto, additional, Canavero, Isabella, additional, Saggese, Carlo Emanuele, additional, Plocco, Maurizio, additional, Giorli, Elisa, additional, Palaiodimou, Lina, additional, Bakola, Eleni, additional, Bandini, Fabio, additional, Gasparro, Antonio, additional, Terruso, Valeria, additional, Mannino, Marina, additional, Pezzini, Alessandro, additional, Ornello, Raffaele, additional, Sacco, Simona, additional, Popovic, Nemanja, additional, Scoditti, Umberto, additional, Genovese, Antonio, additional, Flomin, Yuriy, additional, Mancuso, Michelangelo, additional, D'agliano, Roberto, additional, Baldini, Marco, additional, Ulivi, Leonardo, additional, Giannini, Nicola, additional, Vadikolias, Konstantinos, additional, Liantinioti, Chrysoula, additional, Chondrogianni, Maria, additional, Halvatsiotis, Panagiotis, additional, Karagkiozi, Efstathia, additional, Athanasakis, George, additional, Makaritsis, Konstantinos, additional, lanari, alessia, additional, Tatlisumak, Turgut, additional, Acciarresi, Monica, additional, Lorenzini, Gianni, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Martini, Giuseppe, additional, Sohn, Sung-Il, additional, Mumoli, Nicola, additional, Cararra, Davide, additional, Maccarrone, Miriam, additional, Galati, Franco, additional, Gourbali, Vanessa, additional, Orlandi, Giovanni, additional, Giuntini, Martina, additional, Corea, Francesco, additional, Bellesini, Marta, additional, Karapanayiotides, Theodore, additional, Csiba, Laszlo, additional, Szabo, Lilla, additional, Imberti, Davide, additional, Pieroni, Alessio, additional, Barlinn, Kristian, additional, Pallesen, Lars-Peder, additional, Barlinn, Jessica, additional, Doronin, Boris, additional, Volodina, Vera Alexandrovna, additional, Agnelli, Giancarlo, additional, Deleu, Dirk, additional, Bonetti, Bruno, additional, Gentile, Luana, additional, Reale, Giuseppe, additional, Caliandro, Pietro, additional, Morotti, Andrea, additional, Vannucchi, Vieri, additional, Padroni, Marina, additional, Letteri, Federica, additional, Magoni, Mauro, additional, Tiseo, Cindy, additional, Rigatelli, Alberto, additional, Zauli, Aurelia, additional, Bossi, Francesco, additional, and Caso, Valeria, additional

Published
2024
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13. Stroke and the heart : a focus on atrial fibrillation and heart failure

Author

Abdul-Rahim, Azmil H.

Subjects
616.1, R Medicine (General)
Abstract

Cardio-embolic stroke accounts for nearly a third of all ischaemic strokes. The most clinically important cardio-embolic sources are non-valvular atrial fibrillation (AF) and chronic heart failure. Strokes due to these conditions are associated with greater disability and more mortality, as compared to stroke of other aetiology. This thesis is aimed at addressing some of the challenges faced by clinicians when dealing with stroke in patients with AF or heart failure, using an extensive range of historical data. Chapter 1 provides an introduction to stroke, AF and heart failure, including current prevalences, aetiology, and their complex intertwine relationship. The current acute stroke management in patients with AF or heart failure is also outlined within the chapter. In chapter 2, the data sources and statistical methods that were common to the studies in the thesis are outlined. The justifications of using historical data in the absence of evidence from robust clinical trials are also detailed. Chapter 3 explores the relevance of antithrombotic treatment on patterns and outcomes of acute stroke patients with AF. A non-randomised cohort analysis was conducted using data from the Virtual International Stroke Trials Archive (VISTA). The associations of antithrombotic treatment with the modified Rankin scale (mRS) outcome, and the occurrence of recurrent stroke and symptomatic intracerebral haemorrhage, at 90 days after stroke were described. Combined sequential antithrombotic therapy (i.e. oral anticoagulant and antiplatelet treatment), was associated with favourable outcome on ordinal mRS and significantly lower risk of recurrent stroke, symptomatic intracerebral haemorrhage and mortality by day 90, compared to the patients who did not receive any antithrombotic treatment. The relative-risk of recurrent stroke and symptomatic intracerebral haemorrhage appeared highest in the first 2 days after stroke before attenuating to become constant over time. Thus, early introduction of oral anticoagulant treatment (2-3 days after stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer recurrent stroke events over the following weeks but with no excess risk of symptomatic intracerebral haemorrhage. Chapter 4 seeks to describe the current prescribing patterns in stroke survivors with AF, with particular emphasis on socio-demographic associations. A cross-sectional analysis of city-wide Glasgow primary care data for the year 2010, was conducted. This chapter highlights that oral anticoagulant treatment was under-used in this high risk population, especially those of older age and affected by deprivation. Strategies need to be developed to improve prescription of oral anticoagulant treatment. Chapter 5 investigates the incidence of stroke within the available heart failure trials spanning a 30 year period, according to AF status at baseline. Individual patient data were pooled from 11 trials conducted in patients with heart failure and reduced ejection fraction (HF-REF); and, 3 trials performed in patients with heart failure and preserved ejection fraction (HF-PEF). Stroke incidence has not significantly declined over time in patients with HF-REF enrolled to trials, despite greater use of evidence-based heart failure and oral anticoagulant therapies. However, anticoagulation proportions remain under 70% among HF-REF patients with documented AF. Similar trends of stroke incidence were observed for patients enrolled in HF-PEF trials. Some patients with heart failure but without atrial fibrillation may be at high risk of stroke and may potentially benefit from oral anticoagulant treatment. Chapter 6 provides a comprehensive description of the current incidence of and risk factors for stroke in patients with HF-REF but without AF. Data from two large and contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiac- Heart Failure trial (GISSI-HF), were pooled to enable the analysis. The new simple clinical predictive model for stroke showed that about one-third of patients without AF have a risk of stroke similar to patients with AF. The predictive model was also validated in an independent large data set. The high risk of stroke in patients without AF might be reduced by individualised and safer oral anticoagulant treatment. Correspondingly, Chapter 7 explores the risk-model for stroke in a contemporary cohort of patients with HF-PEF but without AF. Data were pooled from the Candesartan in Heart failure Assessment of Reduction in Mortality and Morbidity- Preserved trial (CHARM-Preserved) and the Irbesartan in Heart Failure with Preserved Systolic Function trial (I-Preserve), for patients with ejection fraction ≥45% only. The analysis showed that the simple clinical model developed in Chapter 6, for patients with HF-REF, is also applicable to patients with HF-PEF. There are concerns that systemic thrombolysis might not achieve clinically-important outcome among chronic heart failure patients with acute ischaemic stroke. Chapter 8 evaluates the relevance of chronic heart failure on the outcome of acute stroke patients who received thrombolysis. A non-randomised cohort analysis was conducted using data obtained from the Virtual International Stroke Trials Archive (VISTA). The associations of outcome among chronic heart failure patients with thrombolysis treatment using the mRS distribution at day 90, stratified by presence of AF, were evaluated. Chronic heart failure was associated with a worse outcome with or without thrombolysis. However, acute stroke patients who received thrombolysis had more favourable outcome regardless of heart failure status, compared to their untreated peers. The findings should reassure clinicians considering systemic thrombolysis treatment in hyper-acute ischaemic stroke patients with chronic heart failure. This thesis has summarised and extended our knowledge of the complex relationship between stroke and the heart, focusing on atrial fibrillation and heart failure. It has answered many questions and generated many more. The reported studies may assist clinicians who are dealing with stroke in patients with atrial fibrillation or heart failure. These conditions are common and each carry poor prognosis. Thus, even small advances in their treatment may have a useful societal impact.

Published
2017

15. Impact of bridging thrombolysis versus endovascular thrombectomy alone on outcomes in anticoagulated patients with atrial fibrillation and acute ischaemic stroke.

Author

Alobaida, Muath, Harrison, Stephanie L., Lane, Deirdre A., Rowe, Fiona, Austin, Philip, Abdul‐Rahim, Azmil H., and Lip, Gregory Y. H.

Subjects
ENDOVASCULAR surgery, PROPENSITY score matching, ISCHEMIC stroke, CEREBRAL hemorrhage, ATRIAL fibrillation
Abstract

Background and purpose: The impact of bridging thrombolysis prior to endovascular thrombectomy (EVT) compared to EVT alone on intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), and death in anticoagulated atrial fibrillation (AF) patients with acute ischaemic stroke (AIS) is not well defined. Methods: A retrospective study was conducted using data from a federated research network (TriNetX) including 114 health care organisations in the United States. Anticoagulated AF patients with AIS who received either bridging thrombolysis (BT) or EVT alone from September 2018 to November 2023 were included. Following propensity score matching, Cox regression analyses examined the risk of ICH, SAH, and death within 30 and 90 days, comparing anticoagulated AF patients receiving BT versus EVT only. Results: A total of 3156 patients with AIS were treated with BT or EVT alone. Following 1:1 propensity score matching, the cohort included 766 patients in each group. ICH occurred within 30 and 90 days in 6.9% and 8.0% in the BT group compared with 7.4% and 7.7% in the EVT‐only group (hazard ratios [HR] = 0.92, 95% confidence interval [CI] = 0.63–1.33 and HR = 1.01, 95% CI = 0.71–1.45, respectively). SAH occurred within 30 and 90 days in 4.2% and 4.4% of patients in the BT compared to 3.0% and 3.4% in the EVT‐only group (HR = 1.38, 95% CI = 0.81–2.38 and HR = 1.29, 95% CI = 0.77–2.14, respectively). Death occurred within 30 and 90 days in 17.8% and 19.8% of patients in the BT compared to 22.2% and 27.3% in the EVT‐only group (HR = 0.77, 95% CI = 0.62–0.97 and HR = 0.65, 95% CI = 0.56–0.86, respectively). Conclusions: In anticoagulated AF patients with AIS, BT was associated with a significantly lower risk of death, with no difference in ICH or SAH risk within 30 and 90 days compared to EVT only. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Natriuretic Peptides to Classify Risk of Atrial Fibrillation Detection After Stroke: Analysis of the BIOSIGNAL and PRECISE Cohort Studies.

Author

Cameron, Alan C., Arnold, Markus, Katsas, Georgios, Yang, Jason, Quinn, Terence J., Abdul-Rahim, Azmil H., Campbell, Ross, Docherty, Kieran, De Marchis, Gian Marco, Arnold, Marcel, Kahles, Timo, Nedeltchev, Krassen, Cereda, Carlo W., Kägi, Georg, Bustamante, Alejandro, Montaner, Joan, Ntaios, George, Foerch, Christian, Spanaus, Katharina, and Von Eckardstein, Arnold

Published
2024
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18. Social determinants of health and clinical outcomes among patients with atrial fibrillation: evidence from a global federated health research network.

Author

Simoni, A H, Bucci, T, Romiti, G F, Frydenlund, J, Johnsen, S P, Abdul-Rahim, A H, and Lip, G Y H

Subjects
SOCIAL determinants of health, ATRIAL fibrillation, HEALTH care networks, CORONARY disease, MYOCARDIAL ischemia
Abstract

Background Few studies have investigated the role of social determinants of health (SDoH) in patients with atrial fibrillation (AF). Aim To investigate the relationship between SDoH and adverse events in a large multinational AF cohort. Design Retrospective study utilizing a global federated health research network (TriNetX). Methods Patients with AF were categorized as socially deprived defined according to ICD codes based on three SDoHs: (i) extreme poverty; (ii) unemployment; and/or (iii) problems related with living alone. The outcomes were the 5-year risk of a composite outcomes of all-cause death, hospitalization, ischemic heart disease (IHD), stroke, heart failure (HF) or severe ventricular arrhythmias. Cox regression was used to compute hazard rate ratios (HRs) and 95% confidence intervals (CIs) following 1:1 propensity score matching (PSM). Results The study included 24 631 socially deprived (68.8 ± 16.0 years; females 51.8%) and 2 462 092 non-deprived AF patients (75.5 ± 13.1 years; females 43.8%). Before PSM, socially deprived patients had a higher risk of the composite outcome (HR 1.9, 95% CI 1.87–1.93), all-cause death (HR 1.34, 95% CI 1.28–1.39), hospitalization (HR 2.01, 95% CI 1.98–2.04), IHD (HR 1.67, 95% CI 1.64–1.70), stroke (HR 2.60, 95% CI 2.51–2.64), HF (HR 1.91, 95% CI 1.86–1.96) and severe ventricular arrhythmias (HR 1.83, 95% CI 1.76–1.90) compared to non-deprived AF patients. The PSM-based hazard ratios for the primary composite outcome were 1.54 (95% CI 1.49–1.60) for the unemployed AF patients; 1.39 (95% CI 1.31–1.47) for patients with extreme poverty or with low income; and 1.42 (95% CI 1.37–1.47) for those with problems related with living alone. Conclusions In patients with AF, social deprivation is associated with an increased risk of death and adverse cardiac events. The presence of possible unmeasured bias associated with the retrospective design requires confirmation in future prospective studies. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Natriuretic Peptides Improve Classification of People at Low Risk of Atrial Fibrillation after Stroke

Author

Cameron, Alan C, primary, Arnold, Markus, additional, Katsas, Georgios, additional, Yang, Jason, additional, Quinn, Terence, additional, Abdul-Rahim, Azmil H, additional, Campbell, Ross, additional, Docherty, Kieran, additional, De Marchis, Gian Marco, additional, Arnold, Marcel, additional, Kahles, Timo, additional, Nedeltchev, Krassen, additional, Cereda, Carlo, additional, Kaegi, Georg, additional, Bustamante, Alejandro, additional, Montaner, Joan, additional, Ntaios, George, additional, Foerch, Christian, additional, Spanaus, Katharina, additional, Von Eckardstein, Arnold, additional, Dawson, Jesse, additional, and Katan, Mira, additional

Published
2023
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21. Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Author

Paciaroni, Maurizio, Agnelli, Giancarlo, Giustozzi, Michela, Caso, Valeria, Toso, Elisabetta, Angelini, Filippo, Canavero, Isabella, Micieli, Giuseppe, Antonenko, Kateryna, Rocco, Alessandro, Diomedi, Marina, Katsanos, Aristeidis H., Shoamanesh, Ashkan, Giannopoulos, Sotirios, Ageno, Walter, Pegoraro, Samuela, Putaala, Jukka, Strbian, Daniel, Sallinen, Hanne, Mac Grory, Brian C., Furie, Karen L., Stretz, Christoph, Reznik, Michael E., Alberti, Andrea, Venti, Michele, Mosconi, Maria Giulia, Vedovati, Maria Cristina, Franco, Laura, Zepponi, Giorgia, Romoli, Michele, Zini, Andrea, Brancaleoni, Laura, Riva, Letizia, Silvestrelli, Giorgio, Ciccone, Alfonso, Zedde, Maria Luisa, Giorli, Elisa, Kosmidou, Maria, Ntais, Evangelos, Palaiodimou, Lina, Halvatsiotis, Panagiotis, Tassinari, Tiziana, Saia, Valentina, Ornello, Raffaele, Sacco, Simona, Bandini, Fabio, Mancuso, Michelangelo, Orlandi, Giovanni, Ferrari, Elena, Pezzini, Alessandro, Poli, Loris, Cappellari, Manuel, Forlivesi, Stefano, Rigatelli, Alberto, Yaghi, Shadi, Scher, Erica, Frontera, Jennifer A., Masotti, Luca, Grifoni, Elisa, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Marcheselli, Simona, Gasparro, Antonio, Terruso, Valeria, Arnao, Valentina, Aridon, Paolo, Abdul-Rahim, Azmil H., Dawson, Jesse, Saggese, Carlo Emanuele, Palmerini, Francesco, Doronin, Boris, Volodina, Vera, Toni, Danilo, Risitano, Angela, Schirinzi, Erika, Del Sette, Massimo, Lochner, Piergiorgio, Monaco, Serena, Mannino, Marina, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Lotti, Enrico Maria, Padroni, Marina, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Ntaios, George, Sagris, Dimitrios, Baldi, Antonio, D’Amore, Cataldo, Mumoli, Nicola, Porta, Cesare, Denti, Licia, Chiti, Alberto, Corea, Francesco, Acciarresi, Monica, Flomin, Yuriy, Popovic, Nemanja, and Tsivgoulis, Georgios

Published
2021
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22. Urate, Blood Pressure, and Cardiovascular Disease: Evidence From Mendelian Randomization and Meta-Analysis of Clinical Trials

Author

Gill, Dipender, Cameron, Alan C., Burgess, Stephen, Li, Xue, Doherty, Daniel J., Karhunen, Ville, Abdul-Rahim, Azmil H., Taylor-Rowan, Martin, Zuber, Verena, Tsao, Philip S., Klarin, Derek, Evangelou, Evangelos, Elliott, Paul, Damrauer, Scott M., Quinn, Terence J., Dehghan, Abbas, Theodoratou, Evropi, Dawson, Jesse, and Tzoulaki, Ioanna

Published
2021
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24. Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

Author

Acciarresi, Monica, Paciaroni, Maurizio, Agnelli, Giancarlo, Falocci, Nicola, Caso, Valeria, Becattini, Cecilia, Marcheselli, Simona, Rueckert, Christina, Pezzini, Alessandro, Morotti, Andrea, Costa, Paolo, Padovani, Alessandro, Csiba, Laszló, Szabó, Lilla, Sohn, Sung-Il, Tassinari, Tiziana, Abdul-Rahim, Azmil H., Michel, Patrik, Cordier, Maria, Vanacker, Peter, Remillard, Suzette, Alberti, Andrea, Venti, Michele, D'Amore, Cataldo, Scoditti, Umberto, Denti, Licia, Orlandi, Giovanni, Chiti, Alberto, Gialdini, Gino, Bovi, Paolo, Carletti, Monica, Rigatelli, Alberto, Putaala, Jukka, Tatlisumak, Turgut, Masotti, Luca, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Martini, Giuseppe, Tsivgoulis, Georgios, Vadikolias, Kostantinos, Liantinioti, Chrissoula, Corea, Francesco, Del Sette, Massimo, Ageno, Walter, De Lodovici, Maria Luisa, Bono, Giorgio, Baldi, Antonio, D'Anna, Sebastiano, Sacco, Simona, Carolei, Antonio, Tiseo, Cindy, Imberti, Davide, Zabzuni, Dorjan, Doronin, Boris, Volodina, Vera, Consoli, Domenico, Galati, Franco, Pieroni, Alessio, Toni, Danilo, Monaco, Serena, Baronello, Mario Maimone, Barlinn, Kristian, Pallesen, Lars-Peder, Kepplinger, Jessica, Bodechtel, Ulf, Gerber, Johannes, Deleu, Dirk, Melikyan, Gayane, Ibrahim, Faisal, Akhtar, Naveed, Mosconi, Maria Giulia, and Lees, Kennedy R.

Published
2017
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26. Safety of Anticoagulation in Patients Treated With Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation

Author

Giustozzi, Michela, Acciarresi, Monica, Agnelli, Giancarlo, Caso, Valeria, Bandini, Fabio, Tsivgoulis, Georgios, Yaghi, Shadi, Furie, Karen L., Tadi, Prasanna, Becattini, Cecilia, Zedde, Marialuisa, Abdul-Rahim, Azmil H., Lees, Kennedy R., Alberti, Andrea, Venti, Michele, D’Amore, Cataldo, Giulia Mosconi, Maria, Anna Cimini, Ludovica, Bovi, Paolo, Carletti, Monica, Rigatelli, Alberto, Cappellari, Manuel, Putaala, Jukka, Tomppo, Liisa, Tatlisumak, Turgut, Marcheselli, Simona, Pezzini, Alessandro, Poli, Loris, Padovani, Alessandro, Vannucchi, Vieri, Sohn, Sung-Il, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Ntaios, George, Athanasakis, George, Makaritsis, Konstantinos, Karagkiozi, Efstathia, Vadikolias, Konstantinos, Liantinioti, Chrissoula, Theodorou, Aikaterini, Halvatsiotis, Panagiotis, Mumoli, Nicola, Galati, Franco, Sacco, Simona, Tiseo, Cindy, Corea, Francesco, Ageno, Walter, Bellesini, Marta, Silvestrelli, Giorgio, Ciccone, Alfonso, Lanari, Alessia, Scoditti, Umberto, Denti, Licia, Mancuso, Michelangelo, Ferrari, Elena, Ulivi, Leonardo, Orlandi, Giovanni, Giannini, Nicola, Tassinari, Tiziana, Luisa De Lodovici, Maria, Rueckert, Christina, Baldi, Antonio, Toni, Danilo, Letteri, Federica, Giuntini, Martina, Maria Lotti, Enrico, Flomin, Yuriy, Pieroni, Alessio, Kargiotis, Odysseas, Karapanayiotides, Theodore, Monaco, Serena, Maimone Baronello, Mario, Csiba, Laszló, Szabó, Lilla, Chiti, Alberto, Giorli, Elisa, Del Sette, Massimo, Imberti, Davide, Zabzuni, Dorjan, Doronin, Boris, Volodina, Vera, Michel, Patrik, Vanacker, Peter, Barlinn, Kristian, Barlinn, Jessica, Deleu, Dirk, Gourbali, Vanessa, Paciaroni, Maurizio, and Masotti, Luca

Published
2020
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29. Preventing Recurrent Cardioembolic Stroke: Right Approach, Right Patient (PRECISE) Study Protocol

Author

Cameron, Alan C; https://orcid.org/0000-0001-6965-1109, Katsas, Georgios, Arnold, Markus; https://orcid.org/0000-0002-5524-2301, Docherty, Kieran, Campbell, Ross T; https://orcid.org/0000-0002-0050-2129, Murdoch, David, McClure, John D; https://orcid.org/0000-0003-4839-5462, Katan, Mira, Lip, Gregory Y H, Abdul-Rahim, Azmil H; https://orcid.org/0000-0002-1318-4027, Dawson, Jesse, Cameron, Alan C; https://orcid.org/0000-0001-6965-1109, Katsas, Georgios, Arnold, Markus; https://orcid.org/0000-0002-5524-2301, Docherty, Kieran, Campbell, Ross T; https://orcid.org/0000-0002-0050-2129, Murdoch, David, McClure, John D; https://orcid.org/0000-0003-4839-5462, Katan, Mira, Lip, Gregory Y H, Abdul-Rahim, Azmil H; https://orcid.org/0000-0002-1318-4027, and Dawson, Jesse

Abstract

Cardiac rhythm monitoring is performed to search for atrial fibrillation (AF) after ischaemic stroke or transient ischaemic attack (TIA). Prolonged cardiac rhythm monitoring increases AF detection but is challenging to implement in many healthcare settings and is not needed for all people after ischaemic stroke/TIA. We aimed to develop and validate a model that includes clinical, electrocardiogram (ECG), blood-based, and genetic biomarkers to identify people with a low probability of AF detection after ischaemic stroke or TIA. We will recruit 675 consenting participants who are aged over 18 years, who were admitted with ischaemic stroke or TIA in the 5 days prior, who are not known to have AF, and who would be suitable for anticoagulation if AF is found. We will collect baseline demographic and clinical data, a 12-lead ECG, and a venous blood sample for blood biomarkers (including midregional pro-atrial natriuretic peptide, MRproANP) and genetic data. We will perform up to 28 days of cardiac rhythm monitoring using an R-test or patch device to search for AF in all participants. The sample size of 675 participants is based on true sensitivity of 92.5%, null hypothesis sensitivity of 80%, 80% power, and 5% significance. The primary outcome is AF detection ≥30 s duration during 28 days of cardiac rhythm monitoring. Secondary outcomes are AF detection at 1-year, recurrent cardiovascular events, and mortality and will be identified by electronic linkage and telephone follow-up. The results will guide the development of a more personalized care pathway to search for AF after ischaemic stroke or TIA. This could help to reduce cardiac rhythm monitoring for people with a low probability of AF detection and allow more intensive cardiac monitoring to be focused on people who are more likely to have AF and benefit. Participants will be consented for their data to be used in future research studies, providing a rich resource for stroke and cardiovascular research communities.

Published
2023

31. Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention: The RENo Study

Author

Paciaroni, Maurizio, Agnelli, Giancarlo, Caso, Valeria, Silvestrelli, Giorgio, Seiffge, David Julian, Engelter, Stefan, De Marchis, Gian Marco, Polymeris, Alexandros, Zedde, Maria Luisa, Yaghi, Shadi, Michel, Patrik, Eskandari, Ashraf, Antonenko, Kateryna, Sohn, Sung-Il, Cappellari, Manuel, Tassinari, Tiziana, Tassi, Rossana, Masotti, Luca, Katsanos, Aristeidis H., Giannopoulos, Sotirios, Acciarresi, Monica, Alberti, Andrea, Venti, Michele, Mosconi, Maria Giulia, Vedovati, Maria Cristina, Pierini, Patrizia, Giustozzi, Michela, Lotti, Enrico Maria, Ntaios, George, Kargiotis, Odysseas, Monaco, Serena, Lochner, Piergiorgio, Bandini, Fabio, Liantinioti, Chrysoula, Palaiodimou, Lina, Abdul-Rahim, Azmil H., Lees, Kennedy, Mancuso, Michelangelo, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Galliazzo, Silvia, Ageno, Walter, Toso, Elisabetta, Angelini, Filippo, Chiti, Alberto, Orlandi, Giovanni, Denti, Licia, Flomin, Yuriy, Marcheselli, Simona, Mumoli, Nicola, Rimoldi, Alexandra, Verrengia, Elena, Schirinzi, Erika, Del Sette, Massimo, Papamichalis, Panagiotis, Komnos, Apostolos, Popovic, Nemanja, Zarkov, Marija, Rocco, Alessandro, Diomedi, Marina, Giorli, Elisa, Ciccone, Alfonso, Mac Grory, Brian C., Furie, Karen L., Bonetti, Bruno, Saia, Valentina, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Grifoni, Elisa, Padroni, Marina, Karagkiozi, Efstathia, Perlepe, Kalliopi, Makaritsis, Konstantinos, Mannino, Marina, Maccarrone, Miriam, Ulivi, Leonardo, Giannini, Nicola, Ferrari, Elena, Pezzini, Alessandro, Doronin, Boris, Volodina, Vera, Baldi, Antonio, D’Amore, Cataldo, Deleu, Dirk, Corea, Francesco, Putaala, Jukka, Santalucia, Paola, Nardi, Katiuscia, Risitano, Angela, Toni, Danilo, and Tsivgoulis, Georgios

Published
2019
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32. Anticoagulation After Stroke in Patients With Atrial Fibrillation: To Bridge or Not With Low-Molecular-Weight Heparin?

Author

Altavilla, Riccardo, Caso, Valeria, Bandini, Fabio, Agnelli, Giancarlo, Tsivgoulis, Georgios, Yaghi, Shadi, Furie, Karen L., Tadi, Prasanna, Becattini, Cecilia, Zedde, Marialuisa, Abdul-Rahim, Azmil H., Lees, Kennedy R., Alberti, Andrea, Venti, Michele, Acciarresi, Monica, D’Amore, Cataldo, Giulia Mosconi, Maria, Anna Cimini, Ludovica, Fusaro, Jessica, Bovi, Paolo, Carletti, Monica, Rigatelli, Alberto, Cappellari, Manuel, Putaala, Jukka, Tomppo, Liisa, Tatlisumak, Turgut, Marcheselli, Simona, Pezzini, Alessandro, Poli, Loris, Padovani, Alessandro, Masotti, Luca, Vannucchi, Vieri, Sohn, Sung-Il, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Ntaios, George, Athanasakis, George, Makaritsis, Konstantinos, Karagkiozi, Efstathia, Vadikolias, Konstantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Mumoli, Nicola, Consoli, Domenico, Galati, Franco, Sacco, Simona, Carolei, Antonio, Tiseo, Cindy, Corea, Francesco, Ageno, Walter, Bellesini, Marta, Silvestrelli, Giorgio, Ciccone, Alfonso, Lanari, Alessia, Scoditti, Umberto, Denti, Licia, Mancuso, Michelangelo, Maccarrone, Miriam, Ulivi, Leonardo, Orlandi, Giovanni, Giannini, Nicola, Gialdini, Gino, Tassinari, Tiziana, De Lodovici, Maria Luisa, Bono, Giorgio, Rueckert, Christina, Baldi, Antonio, D’Anna, Sebastiano, Toni, Danilo, Letteri, Federica, Giuntini, Martina, Maria Lotti, Enrico, Flomin, Yuriy, Pieroni, Alessio, Kargiotis, Odysseas, Karapanayiotides, Theodore, Monaco, Serena, Maimone Baronello, Mario, Csiba, Laszló, Szabó, Lilla, Chiti, Alberto, Giorli, Elisa, Del Sette, Massimo, Imberti, Davide, Zabzuni, Dorjan, Doronin, Boris, Volodina, Vera, Michel, Patrik, Vanacker, Peter, Barlinn, Kristian, Pallesen, Lars-Peder, Barlinn, Jessica, Deleu, Dirk, Melikyan, Gayane, Ibrahim, Faisal, Akhtar, Naveed, Gourbali, Vanessa, and Paciaroni, Maurizio

Published
2019
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35. Atrial fibrillation and stroke

Author

Choi, Sylvia E., primary, Sagris, Dimitrios, additional, Hill, Andrew, additional, Lip, Gregory Y.H., additional, and Abdul-Rahim, Azmil H., additional

Published
2023
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37. Improving detection and management of atrial fibrillation after ischaemic stroke in Glasgow (IMPROVE-AF): A quality improvement project

Author

Johnston, Fiona C., Cameron, Alan C., Colquhoun, Elizabeth, Murdoch, David L., Dawson, Jesse, and Abdul-Rahim, Azmil H.

Subjects
Stroke, Ischemic Attack, Transient, Atrial Fibrillation, Humans, General Medicine, Quality Improvement, Education, Brain Ischemia, Ischemic Stroke
Abstract

Background: The use of cardiac monitoring to detect atrial fibrillation (AF) is routine after ischaemic stroke but is often delayed leaving patients at risk from undetected AF. We sought to improve the detection of AF by delivering early prolonged ‘in-house’ cardiac monitoring. Methods: We collected 3-months of data of people with stroke/transient ischaemic attack (TIA), but without AF, who underwent cardiac monitoring (Phase 1, pre-quality improvement project (QIP)). We then implemented an ‘in-house’ 7-day cardiac monitoring service for 12 months (Phase 2, during QIP). Results: We included 244 people in Phase 1 and 172 in Phase 2. In Phase 1, 232 (95%) people completed cardiac monitoring. Of these, new AF was detected in 10 (4%). Median time from stroke/TIA onset to availability of the monitoring report in Phase 1 was 50 (interquartile range (IQR): 24–123) days. In Phase 2, 166 (97%) of people completed 7-day cardiac monitoring, with new AF detected in 17 (10%). Median time from onset to availability of the report in Phase 2 was 12 (IQR: 9–15) days. In people with AF detected, ‘in-house’ monitoring reduced the time of stroke/TIA onset to anticoagulant commencement from 41 (Phase 1) to 14 (Phase 2) days. Discussion: The QIP has improved AF detection, reduced delays associated with conventional cardiac monitoring and prompted early initiation of oral anticoagulation.

Published
2022

38. The risk of stroke recurrence in patients with atrial fibrillation and reduced ejection fraction

Author

Paciaroni, Maurizio, Agnelli, Giancarlo, Caso, Valeria, Becattini, Cecilia, Mosconi, Maria Giulia, Giustozzi, Michela, Tsivgoulis, Georgios, Seiffge, David Julian, Engelter, Stefan T., Lyrer, Philippe, Polymeris, Alexandros A., Dittrich, Tolga, Zietz, Annaelle, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna M., Yperzeele, Laetitia, Loos, Caroline M.J., Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil H., Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Mac Grory, Brian, Jayaraman, Mahesh, Yaghi, Shadi, Furie, Karen L., Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Lotti, Enrico Maria, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, De Magistris, Ilaria Leone, Cancelloni, Virginia, Kargiotis, Odysseas, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Moci, Marco, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D’Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrios, Giannopoulos, Sotirios, Kosmidou, Maria, Ntais, Evangelos, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Saggese, Carlo Emanuele, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Morotti, Andrea, Magoni, Mauro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Caselli, Maria Chiara, Ulivi, Leonardo, Giannini, Nicola, Vadikolias, Kostantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Carletti, Monica, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Lanari, Alessia, Tatlisumak, Turgut, Acciarresi, Monica, Vannucchi, Vieri, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Sohn, Sung-Il, Mumoli, Nicola, Tadi, Prasanna, Letteri, Federica, Maccarrone, Miriam, Galati, Franco, Tiseo, Cindy, Gourbali, Vanessa, Halvatsiotis, Panagiotis, Orlandi, Giovanni, Giuntini, Martina, Corea, Francesco, Bellesini, Marta, Baronello, Mario Maimone, Karapanayiotides, Theodore, Rueckert, Christina, Csiba, Laszló, Szabó, Lilla, Rigatelli, Alberto, Imberti, Davide, Zabzuni, Dorjan, Pieroni, Alessio, Barlinn, Kristian, Pallesen, Lars-Peder, Barlinn, Jessica, Doronin, Boris, Volodina, Vera, Deleu, Dirk, Bonetti, Bruno, Porta, Cesare, Gentile, Luana, Eskandari, Ashraf, and De Marchis, Gian Marco

Abstract

Background: Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (rEF) (⩽40%), compared to ischemic stroke patients with AF but without rEF.Methods: We performed a retrospective analysis that drew data from prospective studies. The primary outcome was the composite of either ischemic (stroke or systemic embolism), or hemorrhagic events (symptomatic intracranial bleeding and severe extracranial bleeding).Results: The cohort for this analysis comprised 3477 patients with ischemic stroke and AF, of which, 643 (18.3%) had also rEF. After a mean follow-up of 7.5 ± 9.1 months, 375 (10.8%) patients had 382 recorded outcome events, for an annual rate of 18.0%. While the number of primary outcome events in patients with rEF was 86 (13.4%), compared to 289 (10.2%) for the patients without rEF; on multivariable analysis rEF was not associated with the primary outcome (OR 1.25; 95% CI 0.84–1.88). At the end of follow-up, 321 (49.9%) patients with rEF were deceased or disabled (mRS ⩾3), compared with 1145 (40.4%) of those without rEF; on multivariable analysis, rEF was correlated with mortality or disability (OR 1.35; 95% CI 1.03–1.77).Conclusions: In patients with ischemic stroke and AF, the presence of rEF was not associated with the composite outcome of ischemic or hemorrhagic events over short-term follow-up but was associated with increased mortality or disability.

Published
2023
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39. Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Author

Paciaroni, Maurizio, Agnelli, Giancarlo, Falocci, Nicola, Caso, Valeria, Becattini, Cecilia, Marcheselli, Simona, Rueckert, Christina, Pezzini, Alessandro, Poli, Loris, Padovani, Alessandro, Csiba, Laszló, Szabó, Lilla, Sohn, Sung-Il, Tassinari, Tiziana, Abdul-Rahim, Azmil H., Michel, Patrik, Cordier, Maria, Vanacker, Peter, Remillard, Suzette, Alberti, Andrea, Venti, Michele, Acciarresi, Monica, D’Amore, Cataldo, Mosconi, Maria Giulia, Scoditti, Umberto, Denti, Licia, Orlandi, Giovanni, Chiti, Alberto, Gialdini, Gino, Bovi, Paolo, Carletti, Monica, Rigatelli, Alberto, Putaala, Jukka, Tatlisumak, Turgut, Masotti, Luca, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Martini, Giuseppe, Tsivgoulis, Georgios, Vadikolias, Kostantinos, Liantinioti, Chrissoula, Corea, Francesco, Del Sette, Massimo, Ageno, Walter, De Lodovici, Maria Luisa, Bono, Giorgio, Baldi, Antonio, D’Anna, Sebastiano, Sacco, Simona, Carolei, Antonio, Tiseo, Cindy, Imberti, Davide, Zabzuni, Dorjan, Doronin, Boris, Volodina, Vera, Consoli, Domenico, Galati, Franco, Pieroni, Alessio, Toni, Danilo, Monaco, Serena, Baronello, Mario Maimone, Barlinn, Kristian, Pallesen, Lars-Peder, Kepplinger, Jessica, Bodechtel, Ulf, Gerber, Johannes, Deleu, Dirk, Melikyan, Gayane, Ibrahim, Faisal, Akhtar, Naveed, and Lees, Kennedy R.

Published
2016
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41. Predicting stroke in heart failure and reduced ejection fraction without atrial fibrillation

Author

Kondo, Toru, primary, Abdul-Rahim, Azmil H, additional, Talebi, Atefeh, additional, Abraham, William T, additional, Desai, Akshay S, additional, Dickstein, Kenneth, additional, Inzucchi, Silvio E, additional, Køber, Lars, additional, Kosiborod, Mikhail N, additional, Martinez, Felipe A, additional, Packer, Milton, additional, Petrie, Mark, additional, Ponikowski, Piotr, additional, Rouleau, Jean L, additional, Sabatine, Marc S, additional, Swedberg, Karl, additional, Zile, Michael R, additional, Solomon, Scott D, additional, Jhund, Pardeep S, additional, and McMurray, John J V, additional

Published
2022
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42. Predicting stroke in heart failure and reduced ejection fraction without atrial fibrillation

Author

Kondo, Toru, Abdul-Rahim, Azmil H., Talebi, Atefeh, Abraham, William T., Desai, Akshay S., Dickstein, Kenneth, Inzucchi, Silvio E., Køber, Lars, Kosiborod, Mikhail N., Martinez, Felipe A., Packer, Milton, Petrie, Mark, Ponikowski, Piotr, Rouleau, Jean L., Sabatine, Marc S., Swedberg, Karl, Zile, Michael R., Solomon, Scott D., Jhund, Pardeep S., McMurray, John J.V., Kondo, Toru, Abdul-Rahim, Azmil H., Talebi, Atefeh, Abraham, William T., Desai, Akshay S., Dickstein, Kenneth, Inzucchi, Silvio E., Køber, Lars, Kosiborod, Mikhail N., Martinez, Felipe A., Packer, Milton, Petrie, Mark, Ponikowski, Piotr, Rouleau, Jean L., Sabatine, Marc S., Swedberg, Karl, Zile, Michael R., Solomon, Scott D., Jhund, Pardeep S., and McMurray, John J.V.

Abstract

Aims: Patients with heart failure with reduced ejection fraction (HFrEF) are at significant risk of stroke. Anticoagulation reduces this risk in patients with and without atrial fibrillation (AF), but the risk-to-benefit balance in the latter group, overall, is not favourable. Identification of patients with HFrEF, without AF, at the highest risk of stroke may allow targeted and safer use of prophylactic anticoagulant therapy. Methods and results: In a pooled patient-level cohort of the PARADIGM-HF, ATMOSPHERE, and DAPA-HF trials, a previously derived simple risk model for stroke, consisting of three variables (history of prior stroke, insulin-treated diabetes, and plasma N-terminal pro-B-type natriuretic peptide level), was validated. Of the 20 159 patients included, 12 751 patients did not have AF at baseline. Among patients without AF, 346 (2.7%) experienced a stroke over a median follow up of 2.0 years (rate 11.7 per 1000 patient-years). The risk for stroke increased with increasing risk score: fourth quintile hazard ratio (HR) 2.35 [95% confidence interval (CI) 1.60-3.45]; fifth quintile HR 3.73 (95% CI 2.58-5.38), with the first quintile as reference. For patients in the top quintile, the rate of stroke was 21.2 per 1000 patient-years, similar to participants with AF not receiving anticoagulation (20.1 per 1000 patient-years). Model discrimination was good with a C-index of 0.84 (0.75-0.91). Conclusion: It is possible to identify a subset of HFrEF patients without AF with a stroke-risk equivalent to that of patients with AF who are not anticoagulated. In these patients, the risk-to-benefit balance might justify the use of prophylactic anticoagulation, but this hypothesis needs to be tested prospectively.

Published
2022

43. Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

Author

Paciaroni, Maurizio, Agnelli, Giancarlo, Caso, Valeria, Tsivgoulis, Georgios, Furie, Karen L., Tadi, Prasanna, Becattini, Cecilia, Falocci, Nicola, Zedde, Marialuisa, Abdul-Rahim, Azmil H., Lees, Kennedy R., Alberti, Andrea, Venti, Michele, Acciarresi, Monica, D’Amore, Cataldo, Mosconi, Maria Giulia, Cimini, Ludovica Anna, Procopio, Antonio, Bovi, Paolo, Carletti, Monica, Rigatelli, Alberto, Cappellari, Manuel, Putaala, Jukka, Tomppo, Liisa, Tatlisumak, Turgut, Bandini, Fabio, Marcheselli, Simona, Pezzini, Alessandro, Poli, Loris, Padovani, Alessandro, Masotti, Luca, Vannucchi, Vieri, Sohn, Sung-Il, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Ntaios, George, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Vadikolias, Kostantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Mumoli, Nicola, Consoli, Domenico, Galati, Franco, Sacco, Simona, Carolei, Antonio, Tiseo, Cindy, Corea, Francesco, Ageno, Walter, Bellesini, Marta, Colombo, Giovanna, Silvestrelli, Giorgio, Ciccone, Alfonso, Scoditti, Umberto, Denti, Licia, Mancuso, Michelangelo, Maccarrone, Miriam, Orlandi, Giovanni, Giannini, Nicola, Gialdini, Gino, Tassinari, Tiziana, De Lodovici, Maria Luisa, Bono, Giorgio, Rueckert, Christina, Baldi, Antonio, D’Anna, Sebastiano, Toni, Danilo, Letteri, Federica, Giuntini, Martina, Lotti, Enrico Maria, Flomin, Yuriy, Pieroni, Alessio, Kargiotis, Odysseas, Karapanayiotides, Theodore, Monaco, Serena, Baronello, Mario Maimone, Csiba, Laszló, Szabó, Lilla, Chiti, Alberto, Giorli, Elisa, Del Sette, Massimo, Imberti, Davide, Zabzuni, Dorjan, Doronin, Boris, Volodina, Vera, Michel, Patrik, Vanacker, Peter, Barlinn, Kristian, Pallesen, Lars-Peder, Kepplinger, Jessica, Bodechtel, Ulf, Gerber, Johannes, Deleu, Dirk, Melikyan, Gayane, Ibrahim, Faisal, Akhtar, Naveed, Gourbali, Vanessa, and Yaghi, Shadi

Published
2017
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44. Sex and Stroke in Thrombolyzed Patients and Controls

Author

Hametner, Christian, MacIsaac, Rachael L., Kellert, Lars, Abdul-Rahim, Azmil H., Ringleb, Peter A., Lees, Kennedy R., Alexandrov, A., Bath, P.M., Bluhmki, E., Bornstein, N., Chen, C., Claesson, L., Davis, S.M., Donnan, G., Diener, H.C., Fisher, M., Ginsberg, M., Gregson, B., Grotta, J., Hacke, W., Hennerici, M.G., Hommel, M., Kaste, M., Lyden, P., Marler, J., Muir, K., Venketasubramanian, N., Sacco, R., Shuaib, A., Teal, P., Wahlgren, N.G., Warach, S., and Weimar, C.

Published
2017
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45. Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)

Author

Scheitz, Jan F., Abdul-Rahim, Azmil H., MacIsaac, Rachael L., Cooray, Charith, Sucharew, Heidi, Kleindorfer, Dawn, Khatri, Pooja, Broderick, Joseph P., Audebert, Heinrich J., Ahmed, Niaz, Wahlgren, Nils, Endres, Matthias, Nolte, Christian H., and Lees, Kennedy R.

Published
2017
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46. Preventing Recurrent Cardioembolic Stroke: Right Approach, Right Patient (PRECISE) Study Protocol.

Author

Cameron, Alan C., Katsas, Georgios, Arnold, Markus, Docherty, Kieran, Campbell, Ross T., Murdoch, David, McClure, John D., Katan, Mira, Lip, Gregory Y.H., Abdul-Rahim, Azmil H., and Dawson, Jesse

Subjects
STROKE, TRANSIENT ischemic attack, ISCHEMIC stroke, PATIENTS' rights, STROKE units, SCIENTIFIC community, CARDIAC intensive care
Abstract

Cardiac rhythm monitoring is performed to search for atrial fibrillation (AF) after ischaemic stroke or transient ischaemic attack (TIA). Prolonged cardiac rhythm monitoring increases AF detection but is challenging to implement in many healthcare settings and is not needed for all people after ischaemic stroke/TIA. We aimed to develop and validate a model that includes clinical, electrocardiogram (ECG), blood-based, and genetic biomarkers to identify people with a low probability of AF detection after ischaemic stroke or TIA. We will recruit 675 consenting participants who are aged over 18 years, who were admitted with ischaemic stroke or TIA in the 5 days prior, who are not known to have AF, and who would be suitable for anticoagulation if AF is found. We will collect baseline demographic and clinical data, a 12-lead ECG, and a venous blood sample for blood biomarkers (including midregional pro-atrial natriuretic peptide, MRproANP) and genetic data. We will perform up to 28 days of cardiac rhythm monitoring using an R-test or patch device to search for AF in all participants. The sample size of 675 participants is based on true sensitivity of 92.5%, null hypothesis sensitivity of 80%, 80% power, and 5% significance. The primary outcome is AF detection ≥30 s duration during 28 days of cardiac rhythm monitoring. Secondary outcomes are AF detection at 1-year, recurrent cardiovascular events, and mortality and will be identified by electronic linkage and telephone follow-up. The results will guide the development of a more personalized care pathway to search for AF after ischaemic stroke or TIA. This could help to reduce cardiac rhythm monitoring for people with a low probability of AF detection and allow more intensive cardiac monitoring to be focused on people who are more likely to have AF and benefit. Participants will be consented for their data to be used in future research studies, providing a rich resource for stroke and cardiovascular research communities. [ABSTRACT FROM AUTHOR]

Published
2023
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48. Practical “1-2-3-4-Day” Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study

Author

Kimura, Shunsuke, primary, Toyoda, Kazunori, additional, Yoshimura, Sohei, additional, Minematsu, Kazuo, additional, Yasaka, Masahiro, additional, Paciaroni, Maurizio, additional, Werring, David J., additional, Yamagami, Hiroshi, additional, Nagao, Takehiko, additional, Yoshimura, Shinichi, additional, Polymeris, Alexandros, additional, Zietz, Annaelle, additional, Engelter, Stefan T., additional, Kallmünzer, Bernd, additional, Cappellari, Manuel, additional, Chiba, Tetsuya, additional, Yoshimoto, Takeshi, additional, Shiozawa, Masayuki, additional, Kitazono, Takanari, additional, Koga, Masatoshi, additional, Todo, Kenichi, additional, Kimura, Kazumi, additional, Yagita, Yoshiki, additional, Furui, Eisuke, additional, Itabashi, Ryo, additional, Terasaki, Tadashi, additional, Shiokawa, Yoshiaki, additional, Hirano, Teruyuki, additional, Kamiyama, Kenji, additional, Nakagawara, Jyoji, additional, Takizawa, Shunya, additional, Homma, Kazunari, additional, Okuda, Satoshi, additional, Okada, Yasushi, additional, Tokunaga, Keisuke, additional, Kameda, Tomoaki, additional, Kario, Kazuomi, additional, Nagakane, Yoshinari, additional, Hasegawa, Yasuhiro, additional, Akiyama, Hisanao, additional, Shibuya, Satoshi, additional, Mochizuki, Hiroshi, additional, Ito, Yasuhiro, additional, Nakashima, Takahiro, additional, Matsuoka, Hideki, additional, Takamatsu, Kazuhiro, additional, Nishiyama, Kazutoshi, additional, Sato, Shoichiro, additional, Arihiro, Shoji, additional, Inoue, Manabu, additional, Takagi, Masahito, additional, Tanaka, Kanta, additional, Nagatsuka, Kazuyuki, additional, Yamaguchi, Takenori, additional, Hashimoto, Yoichiro, additional, Houkin, Kiyohiro, additional, Kitagawa, Kazuo, additional, Matsumoto, Masayasu, additional, Tanahashi, Norio, additional, Terayama, Yasuo, additional, Uchiyama, Shinichiro, additional, Mori, Etsuro, additional, Furukawa, Yutaka, additional, Kimura, Takeshi, additional, Kumon, Yoshiaki, additional, Nagata, Ken, additional, Nogawa, Shigeru, additional, Sakamoto, Tomohiro, additional, Hirai, Toshinori, additional, Kudo, Kohsuke, additional, Sasaki, Makoto, additional, Kobayashi, Shotai, additional, Hamasaki, Toshimitsu, additional, Giustozzi, Michela, additional, Acciarresi, Monica, additional, Agnelli, Giancarlo, additional, Caso, Valeria, additional, Bandini, Fabio, additional, Tsivgoulis, Georgios, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Tadi, Prasanna, additional, Becattini, Cecilia, additional, Zedde, Marialuisa, additional, Abdul-Rahim, Azmil H, additional, Lees, Kennedy R, additional, Alberti, Andrea, additional, Venti, Michele, additional, D’Amore, Cataldo, additional, Giulia Mosconi, Maria, additional, Anna Cimini, Ludovica, additional, Bovi, Paolo, additional, Carletti, Monica, additional, Rigatelli, Alberto, additional, Putaala, Jukka, additional, Tomppo, Liisa, additional, Tatlisumak, Turgut, additional, Marcheselli, Simona, additional, Pezzini, Alessandro, additional, Poli, Loris, additional, Padovani, Alessandro, additional, Vannucchi, Vieri, additional, Sohn, Sung-Il, additional, Lorenzini, Gianni, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Martini, Giuseppe, additional, Ntaios, George, additional, Athanasakis, George, additional, Makaritsis, Konstantinos, additional, Karagkiozi, Efstathia, additional, Vadikolias, Konstantinos, additional, Liantinioti, Chrissoula, additional, Chondrogianni, Maria, additional, Mumoli, Nicola, additional, Galati, Franco, additional, Sacco, Simona, additional, Tiseo, Cindy, additional, Corea, Francesco, additional, Ageno, Walter, additional, Bellesini, Marta, additional, Colombo, Giovanna, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Lanari, Alessia, additional, Scoditti, Umberto, additional, Denti, Licia, additional, Mancuso, Michelangelo, additional, Maccarrone, Miriam, additional, Ulivi, Leonardo, additional, Orlandi, Giovanni, additional, Giannini, Nicola, additional, Tassinari, Tiziana, additional, De Lodovici, Maria Luisa, additional, Rueckert, Christina, additional, Baldi, Antonio, additional, Toni, Danilo, additional, Letteri, Federica, additional, Giuntini, Martina, additional, Lotti, Enrico Maria, additional, Flomin, Yuriy, additional, Pieroni, Alessio, additional, Kargiotis, Odysseas, additional, Karapanayiotides, Theodore, additional, Monaco, Serena, additional, Baronello, Mario Maimone, additional, Csiba, Laszló, additional, Szabó, Lilla, additional, Chiti, Alberto, additional, Giorli, Elisa, additional, Del Sette, Massimo, additional, Imberti, Davide, additional, Zabzuni, Dorjan, additional, Doronin, Boris, additional, Volodina, Vera, additional, Michel, Patrik, additional, Vanacker, Peter, additional, Barlinn, Kristian, additional, Pallesen, Lars-Peder, additional, Barlinn, Jessica, additional, Deleu, Dirk, additional, Melikyan, Gayane, additional, Ibrahim, Faisal, additional, Akhtar, Naveed, additional, Gourbali, Vanessa, additional, Masotti, Luca, additional, Parry-Jones, Adrian, additional, Patterson, Chris, additional, Price, Christopher, additional, Elmarimi, Abduelbaset, additional, Parry, Anthea, additional, Nallasivam, Arumug, additional, Mohd Nor, Azlisham, additional, Esis, Bernard, additional, Bruce, David, additional, Roffe, Christine, additional, Holmes, Clare, additional, Cohen, David, additional, Hargroves, David, additional, Mangion, David, additional, Chadha, Dinesh, additional, Vahidassr, Djamil, additional, Manawadu, Dulka, additional, Giallombardo, Elio, additional, Warburton, Elizabeth, additional, Flossman, Enrico, additional, Gunathilagan, Gunaratam, additional, Proschel, Harald, additional, Emsley, Hedley, additional, Anwar, Ijaz, additional, Okwera, James, additional, Putterill, Janet, additional, O’Connell, Janice, additional, Bamford, John, additional, Corrigan, John, additional, Scott, Jon, additional, Birns, Jonathan, additional, Kee, Karen, additional, Saastamoinen, Kari, additional, Pasco, Kath, additional, Dani, Krishna, additional, Sekaran, Lakshmanan, additional, Choy, Lillian, additional, Iveson, Liz, additional, Mamun, Maam, additional, Sajid, Mahmud, additional, Cooper, Martin, additional, Burn, Matthew, additional, Smith, Matthew, additional, Power, Michael, additional, Davis, Michelle, additional, Smyth, Nigel, additional, Veltkamp, Roland, additional, Sharma, Pankaj, additional, Guyler, Paul, additional, O’Mahony, Paul, additional, Wilkinson, Peter, additional, Datta, Prabel, additional, Aghoram, Prasanna, additional, Marsh, Rachel, additional, Luder, Robert, additional, Meenakishundaram, Sanjeevikumar, additional, Subramonian, Santhosh, additional, Leach, Simon, additional, Ispoglou, Sissi, additional, Andole, Sreeman, additional, England, Timothy, additional, Manoj, Aravindakshan, additional, Harrington, Frances, additional, Rehman, Habib, additional, Sword, Jane, additional, Staals, Julie, additional, Mahawish, Karim, additional, Harkness, Kirsty, additional, Shaw, Louise, additional, McCormich, Michael, additional, Sprigg, Nikola, additional, Mansoor, Syed, additional, Krishnamurthy, Vinodh, additional, Lyrer, Philippe A, additional, Bonati, Leo H, additional, Seiffge, David J, additional, Traenka, Christopher, additional, Peters, Nils, additional, De Marchis, Gian Marco, additional, Thilemann, Sebastian, additional, Avramiotis, Nikolaos S, additional, Gensicke, Henrik, additional, Hert, Lisa, additional, Wagner, Benjamin, additional, Schaub, Fabian, additional, Meya, Louisa, additional, Fladt, Joachim, additional, Dittrich, Tolga, additional, Fisch, Urs, additional, Bonetti, Bruno, additional, Tomelleri, Giampaolo, additional, Micheletti, Nicola, additional, Zivelonghi, Cecilia, additional, Emiliani, Andrea, additional, Macha, Kosmas, additional, Siedler, Gabriela, additional, Stoll, Svenja, additional, Wang, Ruihao, additional, Volbers, Bastian, additional, Schwab, Stefan, additional, Haupenthal, David, additional, and Gaßmann, Luise, additional

Published
2022
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49. Oral anticoagulants in the oldest old with recent stroke and atrial fibrillation

Author

Polymeris, A. A., Macha, K., Paciaroni, M., Wilson, D., Koga, M., Cappellari, M., Schaedelin, S., Zietz, A., Peters, N., Seiffge, D. J., Haupenthal, D., Gassmann, L., De Marchis, G. M., Wang, R., Gensicke, H., Stoll, S., Thilemann, S., Avramiotis, N. S., Bonetti, B., Tsivgoulis, G., Ambler, G., Alberti, A., Yoshimura, S., Brown, M. M., Shiozawa, M., Lip, G. Y. H., Venti, M., Acciarresi, M., Tanaka, K., Mosconi, M. G., Takagi, M., Jager, R. H., Muir, K., Inoue, M., Schwab, S., Bonati, L. H., Lyrer, P. A., Toyoda, K., Caso, V., Werring, D. J., Kallmunzer, B., Engelter, S. T., Traenka, C., Hert, L., Wagner, B., Schaub, F., Meya, L., Fladt, J., Dittrich, T., Fisch, U., Volbers, B., Siedler, G., Bovi, P., Tomelleri, G., Micheletti, N., Zivelonghi, C., Emiliani, A., Parry-Jones, A., Patterson, C., Price, C., Elmarimi, A., Parry, A., Nallasivam, A., Nor, A. M., Esis, B., Bruce, D., Bhaskaran, B., Roffe, C., Cullen, C., Holmes, C., Cohen, D., Hargroves, D., Mangion, D., Chadha, D., Vahidassr, D., Manawadu, D., Giallombardo, E., Warburton, E., Flossman, E., Gunathilagan, G., Proschel, H., Emsley, H., Anwar, I., Burger, I., Okwera, J., Putterill, J., O'Connell, J., Bamford, J., Corrigan, J., Scott, J., Birns, J., Kee, K., Saastamoinen, K., Pasco, K., Dani, K., Sekaran, L., Choy, L., Iveson, L., Mamun, M., Sajid, M., Cooper, M., Burn, M., Smith, M., Power, M., Davis, M., Smyth, N., Veltkamp, R., Sharma, P., Guyler, P., O'Mahony, P., Wilkinson, P., Datta, P., Aghoram, P., Marsh, R., Luder, R., Meenakishundaram, S., Subramonian, S., Leach, S., Ispoglou, S., Andole, S., England, T., Manoj, A., Harrington, F., Rehman, H., Sword, J., Staals, J., Mahawish, K., Harkness, K., Shaw, L., Mccormich, M., Sprigg, N., Mansoor, S., Krishnamurthy, V., Giustozzi, M., Agnelli, G., Becattini, C., D'Amore, C., Cimini, L. A., Bandini, F., Liantinioti, C., Chondrogianni, M., Yaghi, S., Furie, K. L., Tadi, P., Zedde, M., Abdul-Rahim, A. H., Lees, K. R., Carletti, M., Rigatelli, A., Putaala, J., Tomppo, L., Tatlisumak, T., Marcheselli, S., Pezzini, A., Poli, L., Padovani, A., Vannucchi, V., Masotti, L., Sohn, S. -I., Lorenzini, G., Tassi, R., Guideri, F., Acampa, M., Martini, G., Ntaios, G., Athanasakis, G., Makaritsis, K., Karagkiozi, E., Vadikolias, K., Mumoli, N., Galati, F., Sacco, S., Tiseo, C., Corea, F., Ageno, W., Bellesini, M., Colombo, G., Silvestrelli, G., Ciccone, A., Lanari, A., Scoditti, U., Denti, L., Mancuso, M., Maccarrone, M., Ulivi, L., Orlandi, G., Giannini, N., Tassinari, T., De Lodovici, M. L., Rueckert, C., Baldi, A., Toni, D., Letteri, F., Pieroni, A., Giuntini, M., Lotti, E. M., Flomin, Y., Kargiotis, O., Karapanayiotides, T., Monaco, S., Baronello, M. M., Csiba, L., Szabo, L., Chiti, A., Giorli, E., Del Sette, M., Imberti, D., Zabzuni, D., Doronin, B., Volodina, V., Michel, P., Vanacker, P., Barlinn, K., Pallesen, L. -P., Barlinn, J., Deleu, D., Melikyan, G., Ibrahim, F., Akhtar, N., Gourbali, V., Todo, K., Kimura, K., Shibazaki, K., Yagita, Y., Furui, E., Itabashi, R., Terasaki, T., Shiokawa, Y., Hirano, T., Suzuki, R., Kamiyama, K., Nakagawara, J., Takizawa, S., Homma, K., Okuda, S., Okada, Y., Maeda, K., Kameda, T., Kario, K., Nagakane, Y., Hasegawa, Y., Akiyama, H., Shibuya, S., Mochizuki, H., Ito, Y., Nakashima, T., Matsuoka, H., Takamatsu, K., Nishiyama, K., Endo, K., Miyagi, T., Osaki, M., Kobayashi, J., Okata, T., Tanaka, E., Sakamoto, Y., Tokunaga, K., Takizawa, H., Takasugi, J., Matsubara, S., Higashida, K., Matsuki, T., Kinoshita, N., Ide, T., Yoshimoto, T., Ando, D., Fujita, K., Kumamoto, M., Kamimura, T., Kikuno, M., Mizoguchi, T., and Sato, T.

Subjects
Male, medicine.medical_specialty, Vitamin K, medicine.drug_class, 610 Medicine & health, Aged, 80 and over, Atrial Fibrillation, Factor Xa Inhibitors, Female, Humans, Stroke, Continuous variable, Internal medicine, 80 and over, medicine, Aged, Proportional hazards model, business.industry, Anticoagulant, Confounding, Atrial fibrillation, Patient data, medicine.disease, Oldest old, Neurology, Neurology (clinical), 610 Medizin und Gesundheit, business
Abstract

Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (≥85y = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR = 0.79, 95%-CI [0.66, 0.95]) in simple (p interaction = 0.129), adjusted (p interaction = 0.094) or weighted (p interaction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1). Interpretation: The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021.

Published
2022
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