Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study
Authors: Paciaroni Maurizio , Agnelli Giancarlo , Falocci Nicola , Tsivgoulis Georgios , Vadikolias Kostantinos , Liantinioti Chrysoula , Chondrogianni Maria , Bovi Paolo , Carletti Monica , Cappellari Manuel , Zedde Marialuisa , Ntaios George , Karagkiozi Efstathia , Athanasakis George , Makaritsis Kostantinos , Silvestrelli Giorgio , Lanari Alessia , Ciccone Alfonso , Putaala Jukka , Tomppo Liisa , Tatlisumak Turgut , Abdul‐Rahim Azmil H. , Lees Kennedy R. , Alberti Andrea , Venti Michele , Acciarresi Monica , D'Amore Cataldo , Becattini Cecilia , Mosconi Maria Giulia , Cimini Ludovica Anna , Soloperto Rossana , Masotti Luca , Vannucchi Vieri , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Martini Giuseppe , Sohn Sung‐Il , Marcheselli Simona , Mumoli Nicola , De Lodovici Maria Luisa , Bono Giorgio , Furie Karen L. , Tadi Prasanna , Yaghi Shadi , Toni Danilo , Letteri Federica , Tassinari Tiziana , Kargiotis Odysseas , Lotti Enrico Maria , Flomin Yuriy , Mancuso Michelangelo , Maccarrone Miriam , Giannini Nicola , Bandini Fabio , Pezzini Alessandro , Poli Loris , Padovani Alessandro , Scoditti Umberto , Denti Licia , Consoli Domenico , Galati Franco , Sacco Simona , Carolei Antonio , Tiseo Cindy , Gourbali Vanessa , Orlandi Giovanni , Giuntini Martina , Chiti Alberto , Giorli Elisa , Gialdini Gino , Corea Francesco , Ageno Walter , Bellesini Marta , Colombo Giovanna , Monaco Serena , Maimone Baronello Mario , Karapanayiotides Theodore , Caso Valeria 
Published: November 2017

Background

The optimal timing to administer non–vitamin K oral anticoagulants (
NOAC
s) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within 90 days) and their timing in patients with acute ischemic stroke and atrial fibrillation who received
NOAC
s for secondary prevention.

Methods and Results

Recurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a
CHA
2
DS
2
‐
VAS
c score >4 and less reduced renal function. Thirty‐two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated
NOAC
s within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated >14 days after acute stroke.

Conclusions

In patients with acute ischemic stroke and atrial fibrillation, treatment with
NOAC
s was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.