engleski

Do patients with stroke and newly diagnosed atrial fibrillation have benefit from prior treatment with acetylsalicylic acid?

Background and aims: Atrial fibrillation causes more severe strokes and it is related to higher mortality. Antithrombotic therapy is effective for primary and secondary stroke prevention. Objective: To determine the effect of prior antithrombotic therapy in first-ever acute stroke in patients with nonvalvular atrial fibrillation. Methods: This retrospective study included 780 hospitalized patients with acute stroke and atrial fibrillation during a ten-year period. Patients were divided into three groups according to prior antithrombotic therapy. Stroke severity was assessed according to National Institutes of Health Stroke Scale (NIHSS). Stroke outcome was assessed by the modified Rankin scale (mRS) at hospital discharge. Results: The study included 124 patients with prior warfarin therapy ; 221 patients with prior acetylsalicylic acid therapy and 435 patients with no prior antithrombotic therapy. Risk factors (diabetes mellitus, arterial hypertension, hyperlipidaemia, cardiomyopathy) were significantly lower in the group with no prior antithrombotic treatment. Patients in the warfarin group were the youngest (p<0.001), had a significantly lower cognitive decline frequency (p=0.007), the best treatment outcome assessed by mRS (p=0.006) and had a better outcome (mRS≤2) more often (p=0.04). No statistically significant difference was found in initial presentation and in-hospital mortality. Conclusion: Prior anticoagulant treatment in patients with acute ischemic stroke and atrial fibrillation is associated with younger age, less severe stroke and more favourable clinical outcome. Prior acetylsalicylic acid therapy showed the lowest benefit in clinical outcome in patients with acute ischemic stroke and atrial fibrillation compared to patients with warfarin or with no prior treatment.

acute stroke ; atrial fibrillation ; prior antithrombotic

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