Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study

Maurizio Paciaroni, Giancarlo Agnelli, Nicola Falocci, Georgios Tsivgoulis, Kostantinos Vadikolias, Chrysoula Liantinioti, Maria Chondrogianni, Paolo Bovi, Monica Carletti, Manuel Cappellari, Marialuisa Zedde, George Ntaios, Efstathia Karagkiozi, George Athanasakis, Kostantinos Makaritsis, Giorgio Silvestrelli, Alessia Lanari, Alfonso Ciccone, Jukka Putaala, Liisa Tomppo & 60 others Turgut Tatlisumak, Azmil H. Abdul-Rahim, Kennedy R. Lees, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D'Amore, Cecilia Becattini, Maria Giulia Mosconi, Ludovica Anna Cimini, Rossana Soloperto, Luca Masotti, Vieri Vannucchi, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, Sung Il Sohn, Simona Marcheselli, Nicola Mumoli, Maria Luisa De Lodovici, Giorgio Bono, Karen L. Furie, Prasanna Tadi, Shadi Yaghi, Danilo Toni, Federica Letteri, Tiziana Tassinari, Odysseas Kargiotis, Enrico Maria Lotti, Yuriy Flomin, Michelangelo Mancuso, Miriam Maccarrone, Nicola Giannini, Fabio Bandini, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Umberto Scoditti, Licia Denti, Domenico Consoli, Franco Galati, Simona Sacco, Antonio Carolei, Cindy Tiseo, Vanessa Gourbali, Giovanni Orlandi, Martina Giuntini, Alberto Chiti, Elisa Giorli, Gino Gialdini, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Serena Monaco, Mario Maimone Baronello, Theodore Karapanayiotides, Valeria Caso

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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 (within90 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.

Original languageEnglish (US)
Article numbere007034
JournalJournal of the American Heart Association
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2017

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Anticoagulants
Atrial Fibrillation
Stroke
Hemorrhage
Recurrence
Transient Ischemic Attack
National Institutes of Health (U.S.)
Secondary Prevention
Embolism
Multicenter Studies
Observational Studies
Kidney
Dabigatran

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study. / 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; Baronello, Mario Maimone; Karapanayiotides, Theodore; Caso, Valeria.

In: Journal of the American Heart Association, Vol. 6, No. 12, e007034, 01.12.2017.

Research output: Contribution to journalArticle

Paciaroni, M, Agnelli, G, Falocci, N, Tsivgoulis, G, Vadikolias, K, Liantinioti, C, Chondrogianni, M, Bovi, P, Carletti, M, Cappellari, M, Zedde, M, Ntaios, G, Karagkiozi, E, Athanasakis, G, Makaritsis, K, Silvestrelli, G, Lanari, A, Ciccone, A, Putaala, J, Tomppo, L, Tatlisumak, T, Abdul-Rahim, AH, Lees, KR, Alberti, A, Venti, M, Acciarresi, M, D'Amore, C, Becattini, C, Mosconi, MG, Cimini, LA, Soloperto, R, Masotti, L, Vannucchi, V, Lorenzini, G, Tassi, R, Guideri, F, Acampa, M, Martini, G, Sohn, SI, Marcheselli, S, Mumoli, N, De Lodovici, ML, Bono, G, Furie, KL, Tadi, P, Yaghi, S, Toni, D, Letteri, F, Tassinari, T, Kargiotis, O, Lotti, EM, Flomin, Y, Mancuso, M, Maccarrone, M, Giannini, N, Bandini, F, Pezzini, A, Poli, L, Padovani, A, Scoditti, U, Denti, L, Consoli, D, Galati, F, Sacco, S, Carolei, A, Tiseo, C, Gourbali, V, Orlandi, G, Giuntini, M, Chiti, A, Giorli, E, Gialdini, G, Corea, F, Ageno, W, Bellesini, M, Colombo, G, Monaco, S, Baronello, MM, Karapanayiotides, T & Caso, V 2017, 'Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study', Journal of the American Heart Association, vol. 6, no. 12, e007034. https://doi.org/10.1161/JAHA.117.007034
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 ; Baronello, Mario Maimone ; Karapanayiotides, Theodore ; Caso, Valeria. / Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 12.
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title = "Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study",
abstract = "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 (within90 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.",
author = "Maurizio Paciaroni and Giancarlo Agnelli and Nicola Falocci and Georgios Tsivgoulis and Kostantinos Vadikolias and Chrysoula Liantinioti and Maria Chondrogianni and Paolo Bovi and Monica Carletti and Manuel Cappellari and Marialuisa Zedde and George Ntaios and Efstathia Karagkiozi and George Athanasakis and Kostantinos Makaritsis and Giorgio Silvestrelli and Alessia Lanari and Alfonso Ciccone and Jukka Putaala and Liisa Tomppo and Turgut Tatlisumak and Abdul-Rahim, {Azmil H.} and Lees, {Kennedy R.} and Andrea Alberti and Michele Venti and Monica Acciarresi and Cataldo D'Amore and Cecilia Becattini and Mosconi, {Maria Giulia} and Cimini, {Ludovica Anna} and Rossana Soloperto and Luca Masotti and Vieri Vannucchi and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Maurizio Acampa and Giuseppe Martini and Sohn, {Sung Il} and Simona Marcheselli and Nicola Mumoli and {De Lodovici}, {Maria Luisa} and Giorgio Bono and Furie, {Karen L.} and Prasanna Tadi and Shadi Yaghi and Danilo Toni and Federica Letteri and Tiziana Tassinari and Odysseas Kargiotis and Lotti, {Enrico Maria} and Yuriy Flomin and Michelangelo Mancuso and Miriam Maccarrone and Nicola Giannini and Fabio Bandini and Alessandro Pezzini and Loris Poli and Alessandro Padovani and Umberto Scoditti and Licia Denti and Domenico Consoli and Franco Galati and Simona Sacco and Antonio Carolei and Cindy Tiseo and Vanessa Gourbali and Giovanni Orlandi and Martina Giuntini and Alberto Chiti and Elisa Giorli and Gino Gialdini and Francesco Corea and Walter Ageno and Marta Bellesini and Giovanna Colombo and Serena Monaco and Baronello, {Mario Maimone} and Theodore Karapanayiotides and Valeria Caso",
year = "2017",
month = "12",
day = "1",
doi = "10.1161/JAHA.117.007034",
language = "English (US)",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Falocci, Nicola

AU - Tsivgoulis, Georgios

AU - Vadikolias, Kostantinos

AU - Liantinioti, Chrysoula

AU - Chondrogianni, Maria

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Cappellari, Manuel

AU - Zedde, Marialuisa

AU - Ntaios, George

AU - Karagkiozi, Efstathia

AU - Athanasakis, George

AU - Makaritsis, Kostantinos

AU - Silvestrelli, Giorgio

AU - Lanari, Alessia

AU - Ciccone, Alfonso

AU - Putaala, Jukka

AU - Tomppo, Liisa

AU - Tatlisumak, Turgut

AU - Abdul-Rahim, Azmil H.

AU - Lees, Kennedy R.

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - D'Amore, Cataldo

AU - Becattini, Cecilia

AU - Mosconi, Maria Giulia

AU - Cimini, Ludovica Anna

AU - Soloperto, Rossana

AU - Masotti, Luca

AU - Vannucchi, Vieri

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Acampa, Maurizio

AU - Martini, Giuseppe

AU - Sohn, Sung Il

AU - Marcheselli, Simona

AU - Mumoli, Nicola

AU - De Lodovici, Maria Luisa

AU - Bono, Giorgio

AU - Furie, Karen L.

AU - Tadi, Prasanna

AU - Yaghi, Shadi

AU - Toni, Danilo

AU - Letteri, Federica

AU - Tassinari, Tiziana

AU - Kargiotis, Odysseas

AU - Lotti, Enrico Maria

AU - Flomin, Yuriy

AU - Mancuso, Michelangelo

AU - Maccarrone, Miriam

AU - Giannini, Nicola

AU - Bandini, Fabio

AU - Pezzini, Alessandro

AU - Poli, Loris

AU - Padovani, Alessandro

AU - Scoditti, Umberto

AU - Denti, Licia

AU - Consoli, Domenico

AU - Galati, Franco

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Tiseo, Cindy

AU - Gourbali, Vanessa

AU - Orlandi, Giovanni

AU - Giuntini, Martina

AU - Chiti, Alberto

AU - Giorli, Elisa

AU - Gialdini, Gino

AU - Corea, Francesco

AU - Ageno, Walter

AU - Bellesini, Marta

AU - Colombo, Giovanna

AU - Monaco, Serena

AU - Baronello, Mario Maimone

AU - Karapanayiotides, Theodore

AU - Caso, Valeria

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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 (within90 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.

AB - 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 (within90 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.

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U2 - 10.1161/JAHA.117.007034

DO - 10.1161/JAHA.117.007034

M3 - Article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 12

M1 - e007034

ER -