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KMID : 1142120210230010113
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Journal of Stroke
2021 Volume.23 No. 1 p.113 ~ p.123
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Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke
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Eun Mi-Yeon
Kim Jae-Young
Hwang Yang-Ha
Park Man-Seok
Kim Joon-Tae
Choi Kang-Ho
Jung Jin-Man
Yu Sung-Wook
Kim Chi-Kyung
Oh Kyung-Mi
Song Tae-Jin
Kim Yong-Jae
Kim Bum-Joon
Heo Sung-Hyuk
Choi Jay-Chol
Chung Jong-Won
Bang Oh-Young
Kim Gyeong-Moon
Seo Woo-Keun
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Abstract
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Background and Purpose: To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF).
Methods: Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered.
Results: Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups.
Conclusions: ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.
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KEYWORD
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Stroke, Atrial fibrillation, Guideline, Anticoagulants, Outcome
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