Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy
Background/purpose: Atrial fibrillation (AF) patients with a history of ischemic stroke or transient ischemic attack (TIA) carry excessive risk of recurrent stroke. Real-world data for the Asian population is scarce. This study aimed to investigate the thromboembolism and major bleeding risk of non-...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664620300401 |
| _version_ | 1819159513794609152 |
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| author | Shin-Yi Lin Sung-Chun Tang Li-Kai Tsai Shin-Joe Yeh Chih-Fen Huang Jiann-Shing Jeng |
| author_facet | Shin-Yi Lin Sung-Chun Tang Li-Kai Tsai Shin-Joe Yeh Chih-Fen Huang Jiann-Shing Jeng |
| author_sort | Shin-Yi Lin |
| collection | DOAJ |
| description | Background/purpose: Atrial fibrillation (AF) patients with a history of ischemic stroke or transient ischemic attack (TIA) carry excessive risk of recurrent stroke. Real-world data for the Asian population is scarce. This study aimed to investigate the thromboembolism and major bleeding risk of non-vitamin K antagonist oral anticoagulant (NOAC) therapy among Asian patients, and to identify the risk factors of recurrent stroke. Methods: This retrospective study recruited AF patients aged over 20 years, who had a previous stoke or TIA, and received NOAC therapy. Thromboembolic events were recurrent ischemic stroke or TIA, and the major bleeding events were classified according to the PLATO (Platelet Inhibition and Patient Outcomes) criteria. Results: A total of 361 patients (61.2% male) were enrolled for data analysis. The incidence rate for recurrent ischemic stroke or TIA was 3.6 (95% CI = 2.5 to 5.5) per 100 person-years, and 0.9 (95% CI = 0.4 to 1.7) per 100 person-years for major bleeding. Patients with recurrent ischemic stroke or TIA were more likely to have malignancy (hazard ratio [HR] for malignancy = 4.4, 95% CI = 1.9 to 10.3, p = 0.001) and concomitantly take enzyme inducing antiepileptic drugs (EIAED, HR = 8.1, 95% CI = 2.7 to 24.1, p < 0.001). Conclusion: Atrial fibrillation patients with underlying malignancy or concurrently use of EIAED may have increased risk of treatment failure in secondary stroke prevention. |
| first_indexed | 2024-12-22T16:41:45Z |
| format | Article |
| id | doaj.art-96bff1718db8450b86a498f8578a2d5f |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-22T16:41:45Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-96bff1718db8450b86a498f8578a2d5f2022-12-21T18:19:51ZengElsevierJournal of the Formosan Medical Association0929-66462020-12-011191217991806Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapyShin-Yi Lin0Sung-Chun Tang1Li-Kai Tsai2Shin-Joe Yeh3Chih-Fen Huang4Jiann-Shing Jeng5Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, TaiwanDepartment of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Corresponding author. No. 7, Chung-Shan South Road, Taipei 100, Taiwan. Fax: +886 2 23418395.Background/purpose: Atrial fibrillation (AF) patients with a history of ischemic stroke or transient ischemic attack (TIA) carry excessive risk of recurrent stroke. Real-world data for the Asian population is scarce. This study aimed to investigate the thromboembolism and major bleeding risk of non-vitamin K antagonist oral anticoagulant (NOAC) therapy among Asian patients, and to identify the risk factors of recurrent stroke. Methods: This retrospective study recruited AF patients aged over 20 years, who had a previous stoke or TIA, and received NOAC therapy. Thromboembolic events were recurrent ischemic stroke or TIA, and the major bleeding events were classified according to the PLATO (Platelet Inhibition and Patient Outcomes) criteria. Results: A total of 361 patients (61.2% male) were enrolled for data analysis. The incidence rate for recurrent ischemic stroke or TIA was 3.6 (95% CI = 2.5 to 5.5) per 100 person-years, and 0.9 (95% CI = 0.4 to 1.7) per 100 person-years for major bleeding. Patients with recurrent ischemic stroke or TIA were more likely to have malignancy (hazard ratio [HR] for malignancy = 4.4, 95% CI = 1.9 to 10.3, p = 0.001) and concomitantly take enzyme inducing antiepileptic drugs (EIAED, HR = 8.1, 95% CI = 2.7 to 24.1, p < 0.001). Conclusion: Atrial fibrillation patients with underlying malignancy or concurrently use of EIAED may have increased risk of treatment failure in secondary stroke prevention.http://www.sciencedirect.com/science/article/pii/S0929664620300401Atrial fibrillationNon-vitamin K antagonist oral anticoagulantsRecurrent strokeAsianMalignancy |
| spellingShingle | Shin-Yi Lin Sung-Chun Tang Li-Kai Tsai Shin-Joe Yeh Chih-Fen Huang Jiann-Shing Jeng Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy Journal of the Formosan Medical Association Atrial fibrillation Non-vitamin K antagonist oral anticoagulants Recurrent stroke Asian Malignancy |
| title | Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy |
| title_full | Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy |
| title_fullStr | Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy |
| title_full_unstemmed | Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy |
| title_short | Factors for recurrent stroke among Asian patients with non-valvular atrial fibrillation under non-vitamin K antagonist oral anticoagulant therapy |
| title_sort | factors for recurrent stroke among asian patients with non valvular atrial fibrillation under non vitamin k antagonist oral anticoagulant therapy |
| topic | Atrial fibrillation Non-vitamin K antagonist oral anticoagulants Recurrent stroke Asian Malignancy |
| url | http://www.sciencedirect.com/science/article/pii/S0929664620300401 |
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