Early ischaemic and haemorrhagic complications after atrial fibrillation-related ischaemic stroke: Analysis of the IAC study

Shadi Yaghi, Nils Henninger, Erica Scher, James Giles, Angela Liu, Muhammad Nagy, Ashutosh Kaushal, Idrees Azher, Idrees Azher, Brian Mac Grory, Hiba Fakhri, Kiersten Brown Espaillat, Syed Daniyal Asad, Hemanth Pasupuleti, Heather Martin, Jose Tan, Manivannan Veerasamy, Ava L. Liberman, Charles Esenwa, Natalie ChengKhadean Moncrieffe, Iman Moeini-Naghani, Mithilesh Siddu, Tushar Trivedi, Christopher R. Leon Guerrero, Muhib Khan, Muhib Khan, Amre Nouh, Eva Mistry, Salah Keyrouz, Karen Furie

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction Predictors of long-term ischaemic and haemorrhagic complications in atrial fibrillation (AF) have been studied, but there are limited data on predictors of early ischaemic and haemorrhagic complications after AF-associated ischaemic stroke. We sought to determine these predictors. Methods The Initiation of Anticoagulation after Cardioembolic stroke study is a multicentre retrospective study across that pooled data from consecutive patients with ischaemic stroke in the setting of AF from stroke registries across eight comprehensive stroke centres in the USA. The coprimary outcomes were recurrent ischaemic event (stroke/TIA/systemic arterial embolism) and delayed symptomatic intracranial haemorrhage (d-sICH) within 90 days. We performed univariate analyses and Cox regression analyses including important predictors on univariate analyses to determine independent predictors of early ischaemic events (stroke/TIA/systemic embolism) and d-sICH. Results Out of 2084 patients, 1520 patients qualified; 104 patients (6.8%) had recurrent ischaemic events and 23 patients (1.5%) had d-sICH within 90 days from the index event. In Cox regression models, factors associated with a trend for recurrent ischaemic events were prior stroke or transient ischemic attack (TIA) (HR 1.42, 95% CI 0.96 to 2.10) and ipsilateral arterial stenosis with 50%-99% narrowing (HR 1.54, 95% CI 0.98 to 2.43). Those associated with sICH were male sex (HR 2.68, 95% CI 1.06 to 6.83), history of hyperlipidaemia (HR 2.91, 95% CI 1.08 to 7.84) and early haemorrhagic transformation (HR 5.35, 95% CI 2.22 to 12.92). Conclusion In patients with ischaemic stroke and AF, predictors of d-sICH are different than those of recurrent ischaemic events; therefore, recognising these predictors may help inform early stroke versus d-sICH prevention strategies.

Original languageEnglish (US)
Pages (from-to)750-755
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume91
Issue number7
DOIs
StatePublished - Jul 1 2020
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

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