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Admission severity of atrial-fibrillation-related acute ischemic stroke in patients under anticoagulation treatment: a systematic review and meta-analysis
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Orientador(es)
Resumo(s)
In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants
(DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke
(AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is
unknown if different pre-admission anticoagulants impact the prognosis of AF related AIS (AF-AIS).
We sought to analyze the literature to assess the association between pre-admission anticoagulation
(VKA or DOAC) and admission severity of AF-AIS. Methods: A Systematic literature search (PubMed
and ScienceDirect) between January 2011 to April 2021 was undertaken to identify studies describing
the outcome of AF-AIS. Results: A total of 128 articles were identified. Of 9493 patients, 1767 were
on DOAC, 919 were on therapeutical VKA, 792 were on non-therapeutical VKA and 6015 were not
anticoagulated. In comparison to patients without anticoagulation, patients with therapeutical VKA
and under DOAC presented with less severe stroke (MD −1.69; 95% CI [−2.71, −0.66], p = 0.001
and MD −2.96; 95% Cl [−3.75, −2.18], p < 0.00001, respectively). Patients with non-therapeutical
VKA presented with more severe stroke (MD 1.28; 95% Cl [0.45, 2.12], p = 0.003). Conclusions: In
AF-AIS, patients under therapeutical VKA or DOAC have reduced stroke severity on admission in
comparison to patients without any anticoagulation, with higher magnitude of protection for DOAC.
Descrição
Palavras-chave
Ischemic stroke Atrial fibrillation Oral anticoagulation Stroke severity
Contexto Educativo
Citação
Journal of Clinical Medicine 11 (12): 3563 (2022)
Editora
MDPI