Oral anticoagulant decreases stroke recurrence in patients with atrial fibrillation detected after stroke

Jin-Yi Hsu, Peter Pin-Sung Liu, Luciano A Sposato, Huei-Kai Huang, An-Bang Liu, Edward Chia-Cheng Lai, Swu-Jane Lin, Cheng-Yang Hsieh, Ching-Hui Loh, Jin-Yi Hsu, Peter Pin-Sung Liu, Luciano A Sposato, Huei-Kai Huang, An-Bang Liu, Edward Chia-Cheng Lai, Swu-Jane Lin, Cheng-Yang Hsieh, Ching-Hui Loh

Abstract

Background: Atrial fibrillation detected after stroke (AFDAS) has a lower risk of ischemic stroke recurrence than known atrial fibrillation (KAF). While the benefit of oral anticoagulants (OAC) for preventing ischemic stroke recurrence in KAF is well established, their role in patients with AFDAS is more controversial. This study aimed to evaluate the association between OAC use and the risk of recurrent ischemic stroke in patients with AFDAS in a real-world setting.

Methods: This nationwide retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. Patients hospitalized with a first-ever ischemic stroke and AFDAS confirmed within 30 days after hospitalization were assigned to OAC and non-OAC cohorts. Inverse probability of treatment weighting was applied to balance the baseline characteristics of the cohorts. The primary outcome was ischemic stroke recurrence. Secondary outcomes were intracranial hemorrhage (ICH), death, and the composite outcome of "ischemic stroke recurrence, ICH, or death." Multivariate Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI).

Results: A total of 4,508 hospitalized patients with stroke and AFDAS were identified. Based on OAC use, 2,856 and 1,652 patients were assigned to the OAC and non-OAC groups, respectively. During the follow-up period (median duration, 2.76 years), the OAC cohort exhibited a lower risk of ischemic stroke recurrence (aHR, 0.84; 95% CI, 0.70-0.99), death (aHR, 0.65; 95% CI, 0.58-0.73), and composite outcome (aHR, 0.70; 95% CI, 0.63-0.78) than did the non-OAC cohort. The risk of ICH (aHR, 0.96; 95% CI, 0.62-1.50) was not significantly different between the two cohorts.

Conclusion: OAC use in patients with AFDAS was associated with reduced risk of ischemic stroke recurrence, without an increased risk of ICH. This supports current guidelines recommending OACs for secondary stroke prevention in patients with AF, regardless of the time of diagnosis.

Keywords: anticoagulant; atrial fibrillation; atrial fibrillation detected after stroke; intracranial hemorrhage; ischemic stroke.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Hsu, Liu, Sposato, Huang, Liu, Lai, Lin, Hsieh and Loh.

Figures

FIGURE 1
FIGURE 1
Study design. AFDAS, atrial fibrillation detected after stroke; Hosp, hospitalization; X, prescription of oral anticoagulant; Adm, admission; Dis, discharge; OAC, oral anticoagulant; IS Recur, ischemic stroke recurrence; ICH, intracranial hemorrhage.
FIGURE 2
FIGURE 2
Kaplan–Meier curves for ischemic stroke event-free probability in the OAC and non-OAC cohorts among patients with AFDAS. AFDAS, atrial fibrillation detected after stroke; OAC, oral anticoagulant.

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