RESUMEN
BACKGROUND: The optimal timing to administer non-vitamin K oral anticoagulants (NOACs) 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 NOACs 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 CHA2DS2-VASc 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 NOACs 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 NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.
Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Isquemia Encefálica/prevención & control , Hemorragia/epidemiología , Vitamina K/antagonistas & inhibidores , Enfermedad Aguda , Administración Oral , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/tratamiento farmacológico , Isquemia Encefálica/epidemiología , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Hemorragia/inducido químicamente , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pirazoles/administración & dosificación , Pirazoles/efectos adversos , Piridonas/administración & dosificación , Piridonas/efectos adversos , Recurrencia , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Tasa de Supervivencia/tendencias , Factores de Tiempo , Resultado del TratamientoRESUMEN
Although essential thrombocythemia (ET) may involve thrombotic complications, including arterial or venous thrombosis, there are no reports of major vascular complications, including both arterial and venous thrombosis, in a patient with ET. We report on a patient with a cerebral infarction affecting the right lateral thalamus and a stenotic lesion of the right posterior cerebral artery. This arterial thrombotic event may be related to ET, which was based on results of a bone marrow biopsy specimen. The patient had experienced previous events of thrombosis, splenic infarction with venous thrombosis, and myocardial infarction. The cause of recurrent ischemic events involving both arterial and venous systems may be sustained elevation of platelet counts. Previous thrombosis is an established risk factor for rethrombosis in patients with ET. Efficient cytoreductive therapy with an antiplatelet agent should be considered for the prevention of recurrent thrombosis.