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Comment on the article ‘Recurrent Ischemic Stroke in Patients With Atrial Fibrillation While Receiving Oral Anticoagulants’ published in JAMA Neurology,  https://doi.org/10.1001/jamaneurol.2024.1892.

Comment

Oral anticoagulants (OACs) are highly effective and safe in preventing stroke in atrial fibrillation (AF) patients with and without previous stroke or transient ischaemic attack,2–5 and their use is universally recommended by treatment guidelines.6 This large nationwide observational study analysed five different registries recording clinical diagnoses, drug prescriptions, and causes of death on all Danish patients with ischaemic stroke (IS) and AF who initiated or restarted OACs within 30 days after their entry IS and found that recurrent IS was common and mortality rates were high.1 These findings are largely consistent with the results of a recent combined analysis of individual participant data (IPD) from five pivotal randomized controlled trials (RCTs) of direct oral anticoagulant (DOAC) therapy in AF designed to assess the outcomes of patients with an IS while on study medication during trial follow-up.7 The primary analysis included 1163 patients with a first post-randomization IS while on study medication. During follow-up, the cumulative incidence of recurrent IS at 1 year was 7.0% (95% CI, 5.2%–8.7%), and the cumulative incidence of mortality at 3 months after stroke was 12.4% (95% CI, 10.5%–14.4%).7 The results of this analysis also suggested that the rate of stroke recurrence despite OACs is particularly high in patients treated with OACs at the time of the index event.7

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CardioPulse > Weekly Journal Scan
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