Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Maurizio Paciaroni, Giancarlo Agnelli, Valeria Caso, Giorgio Silvestrelli, David Julian Seiffge, Stefan Engelter, Gian Marco De Marchis, Alexandros Polymeris, Maria Luisa Zedde, Shadi Yaghi, Patrik Michel, Ashraf Eskandari, Kateryna Antonenko, Sung Il Sohn, Manuel Cappellari, Tiziana Tassinari, Rossana Tassi, Luca Masotti, Aristeidis H. Katsanos, Sotirios GiannopoulosMonica Acciarresi, Andrea Alberti, Michele Venti, Maria Giulia Mosconi, Maria Cristina Vedovati, Patrizia Pierini, Michela Giustozzi, Enrico Maria Lotti, George Ntaios, Odysseas Kargiotis, Serena Monaco, Piergiorgio Lochner, Fabio Bandini, Chrysoula Liantinioti, Lina Palaiodimou, Azmil H. Abdul-Rahim, Kennedy Lees, Michelangelo Mancuso, Leonardo Pantoni, Silvia Rosa, Pierluigi Bertora, Silvia Galliazzo, Walter Ageno, Elisabetta Toso, Filippo Angelini, Alberto Chiti, Giovanni Orlandi, Licia Denti, Yuriy Flomin, Simona Marcheselli, Nicola Mumoli, Alexandra Rimoldi, Elena Verrengia, Erika Schirinzi, Massimo Del Sette, Panagiotis Papamichalis, Apostolos Komnos, Nemanja Popovic, Marija Zarkov, Alessandro Rocco, Marina Diomedi, Elisa Giorli, Alfonso Ciccone, Brian C. Mac Grory, Karen L. Furie, Bruno Bonetti, Valentina Saia, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, Elisa Grifoni, Marina Padroni, Efstathia Karagkiozi, Kalliopi Perlepe, Konstantinos Makaritsis, Marina Mannino, Miriam Maccarrone, Leonardo Ulivi, Nicola Giannini, Elena Ferrari, Alessandro Pezzini, Boris Doronin, Vera Volodina, Antonio Baldi, Cataldo D'Amore, Dirk Deleu, Francesco Corea, Jukka Putaala, Paola Santalucia, Katiuscia Nardi, Angela Risitano, Danilo Toni, Georgios Tsivgoulis

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Purpose- Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non-vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods- Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results- Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95-5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63-9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83-3.16), and CHA2DS2-VASc score (OR, 1.72 for each point increase; 95% CI, 1.58-1.88) were associated with ischemic events. Among the CHA2DS2-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33-0.61). Conclusions- In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA2DS2-VASc score were associated with increased risk of cerebrovascular events.

Original languageEnglish
Pages (from-to)2168-2174
Number of pages7
JournalStroke
Volume50
Issue number8
DOIs
Publication statusPublished - Aug 1 2019

Fingerprint

Anticoagulants
Atrial Fibrillation
Stroke
Odds Ratio
Transient Ischemic Attack
Hyperlipidemias
National Institutes of Health (U.S.)
Therapeutics
Case-Control Studies
Dissection
Atherosclerosis
Diabetes Mellitus
Heart Failure
Pathology

Keywords

  • atrial fibrillation
  • humans
  • prevention and control
  • risk factors
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention. / Paciaroni, Maurizio; Agnelli, Giancarlo; Caso, Valeria; Silvestrelli, Giorgio; Seiffge, David Julian; Engelter, Stefan; De Marchis, Gian Marco; Polymeris, Alexandros; Zedde, Maria Luisa; Yaghi, Shadi; Michel, Patrik; Eskandari, Ashraf; Antonenko, Kateryna; Sohn, Sung Il; Cappellari, Manuel; Tassinari, Tiziana; Tassi, Rossana; Masotti, Luca; Katsanos, Aristeidis H.; Giannopoulos, Sotirios; Acciarresi, Monica; Alberti, Andrea; Venti, Michele; Mosconi, Maria Giulia; Vedovati, Maria Cristina; Pierini, Patrizia; Giustozzi, Michela; Lotti, Enrico Maria; Ntaios, George; Kargiotis, Odysseas; Monaco, Serena; Lochner, Piergiorgio; Bandini, Fabio; Liantinioti, Chrysoula; Palaiodimou, Lina; Abdul-Rahim, Azmil H.; Lees, Kennedy; Mancuso, Michelangelo; Pantoni, Leonardo; Rosa, Silvia; Bertora, Pierluigi; Galliazzo, Silvia; Ageno, Walter; Toso, Elisabetta; Angelini, Filippo; Chiti, Alberto; Orlandi, Giovanni; Denti, Licia; Flomin, Yuriy; Marcheselli, Simona; Mumoli, Nicola; Rimoldi, Alexandra; Verrengia, Elena; Schirinzi, Erika; Del Sette, Massimo; Papamichalis, Panagiotis; Komnos, Apostolos; Popovic, Nemanja; Zarkov, Marija; Rocco, Alessandro; Diomedi, Marina; Giorli, Elisa; Ciccone, Alfonso; Mac Grory, Brian C.; Furie, Karen L.; Bonetti, Bruno; Saia, Valentina; Guideri, Francesca; Acampa, Maurizio; Martini, Giuseppe; Grifoni, Elisa; Padroni, Marina; Karagkiozi, Efstathia; Perlepe, Kalliopi; Makaritsis, Konstantinos; Mannino, Marina; Maccarrone, Miriam; Ulivi, Leonardo; Giannini, Nicola; Ferrari, Elena; Pezzini, Alessandro; Doronin, Boris; Volodina, Vera; Baldi, Antonio; D'Amore, Cataldo; Deleu, Dirk; Corea, Francesco; Putaala, Jukka; Santalucia, Paola; Nardi, Katiuscia; Risitano, Angela; Toni, Danilo; Tsivgoulis, Georgios.

In: Stroke, Vol. 50, No. 8, 01.08.2019, p. 2168-2174.

Research output: Contribution to journalArticle

Paciaroni, M, Agnelli, G, Caso, V, Silvestrelli, G, Seiffge, DJ, Engelter, S, De Marchis, GM, Polymeris, A, Zedde, ML, Yaghi, S, Michel, P, Eskandari, A, Antonenko, K, Sohn, SI, Cappellari, M, Tassinari, T, Tassi, R, Masotti, L, Katsanos, AH, Giannopoulos, S, Acciarresi, M, Alberti, A, Venti, M, Mosconi, MG, Vedovati, MC, Pierini, P, Giustozzi, M, Lotti, EM, Ntaios, G, Kargiotis, O, Monaco, S, Lochner, P, Bandini, F, Liantinioti, C, Palaiodimou, L, Abdul-Rahim, AH, Lees, K, Mancuso, M, Pantoni, L, Rosa, S, Bertora, P, Galliazzo, S, Ageno, W, Toso, E, Angelini, F, Chiti, A, Orlandi, G, Denti, L, Flomin, Y, Marcheselli, S, Mumoli, N, Rimoldi, A, Verrengia, E, Schirinzi, E, Del Sette, M, Papamichalis, P, Komnos, A, Popovic, N, Zarkov, M, Rocco, A, Diomedi, M, Giorli, E, Ciccone, A, Mac Grory, BC, Furie, KL, Bonetti, B, Saia, V, Guideri, F, Acampa, M, Martini, G, Grifoni, E, Padroni, M, Karagkiozi, E, Perlepe, K, Makaritsis, K, Mannino, M, Maccarrone, M, Ulivi, L, Giannini, N, Ferrari, E, Pezzini, A, Doronin, B, Volodina, V, Baldi, A, D'Amore, C, Deleu, D, Corea, F, Putaala, J, Santalucia, P, Nardi, K, Risitano, A, Toni, D & Tsivgoulis, G 2019, 'Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention', Stroke, vol. 50, no. 8, pp. 2168-2174. https://doi.org/10.1161/STROKEAHA.119.025350
Paciaroni, Maurizio ; Agnelli, Giancarlo ; Caso, Valeria ; Silvestrelli, Giorgio ; Seiffge, David Julian ; Engelter, Stefan ; De Marchis, Gian Marco ; Polymeris, Alexandros ; Zedde, Maria Luisa ; Yaghi, Shadi ; Michel, Patrik ; Eskandari, Ashraf ; Antonenko, Kateryna ; Sohn, Sung Il ; Cappellari, Manuel ; Tassinari, Tiziana ; Tassi, Rossana ; Masotti, Luca ; Katsanos, Aristeidis H. ; Giannopoulos, Sotirios ; Acciarresi, Monica ; Alberti, Andrea ; Venti, Michele ; Mosconi, Maria Giulia ; Vedovati, Maria Cristina ; Pierini, Patrizia ; Giustozzi, Michela ; Lotti, Enrico Maria ; Ntaios, George ; Kargiotis, Odysseas ; Monaco, Serena ; Lochner, Piergiorgio ; Bandini, Fabio ; Liantinioti, Chrysoula ; Palaiodimou, Lina ; Abdul-Rahim, Azmil H. ; Lees, Kennedy ; Mancuso, Michelangelo ; Pantoni, Leonardo ; Rosa, Silvia ; Bertora, Pierluigi ; Galliazzo, Silvia ; Ageno, Walter ; Toso, Elisabetta ; Angelini, Filippo ; Chiti, Alberto ; Orlandi, Giovanni ; Denti, Licia ; Flomin, Yuriy ; Marcheselli, Simona ; Mumoli, Nicola ; Rimoldi, Alexandra ; Verrengia, Elena ; Schirinzi, Erika ; Del Sette, Massimo ; Papamichalis, Panagiotis ; Komnos, Apostolos ; Popovic, Nemanja ; Zarkov, Marija ; Rocco, Alessandro ; Diomedi, Marina ; Giorli, Elisa ; Ciccone, Alfonso ; Mac Grory, Brian C. ; Furie, Karen L. ; Bonetti, Bruno ; Saia, Valentina ; Guideri, Francesca ; Acampa, Maurizio ; Martini, Giuseppe ; Grifoni, Elisa ; Padroni, Marina ; Karagkiozi, Efstathia ; Perlepe, Kalliopi ; Makaritsis, Konstantinos ; Mannino, Marina ; Maccarrone, Miriam ; Ulivi, Leonardo ; Giannini, Nicola ; Ferrari, Elena ; Pezzini, Alessandro ; Doronin, Boris ; Volodina, Vera ; Baldi, Antonio ; D'Amore, Cataldo ; Deleu, Dirk ; Corea, Francesco ; Putaala, Jukka ; Santalucia, Paola ; Nardi, Katiuscia ; Risitano, Angela ; Toni, Danilo ; Tsivgoulis, Georgios. / Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention. In: Stroke. 2019 ; Vol. 50, No. 8. pp. 2168-2174.
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title = "Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention",
abstract = "Background and Purpose- Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non-vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods- Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results- Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9{\%}) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95{\%} CI, 1.95-5.85), atrial enlargement (OR, 6.64; 95{\%} CI, 4.63-9.52), hyperlipidemia (OR, 2.40; 95{\%} CI, 1.83-3.16), and CHA2DS2-VASc score (OR, 1.72 for each point increase; 95{\%} CI, 1.58-1.88) were associated with ischemic events. Among the CHA2DS2-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95{\%} CI, 0.33-0.61). Conclusions- In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA2DS2-VASc score were associated with increased risk of cerebrovascular events.",
keywords = "atrial fibrillation, humans, prevention and control, risk factors, stroke",
author = "Maurizio Paciaroni and Giancarlo Agnelli and Valeria Caso and Giorgio Silvestrelli and Seiffge, {David Julian} and Stefan Engelter and {De Marchis}, {Gian Marco} and Alexandros Polymeris and Zedde, {Maria Luisa} and Shadi Yaghi and Patrik Michel and Ashraf Eskandari and Kateryna Antonenko and Sohn, {Sung Il} and Manuel Cappellari and Tiziana Tassinari and Rossana Tassi and Luca Masotti and Katsanos, {Aristeidis H.} and Sotirios Giannopoulos and Monica Acciarresi and Andrea Alberti and Michele Venti and Mosconi, {Maria Giulia} and Vedovati, {Maria Cristina} and Patrizia Pierini and Michela Giustozzi and Lotti, {Enrico Maria} and George Ntaios and Odysseas Kargiotis and Serena Monaco and Piergiorgio Lochner and Fabio Bandini and Chrysoula Liantinioti and Lina Palaiodimou and Abdul-Rahim, {Azmil H.} and Kennedy Lees and Michelangelo Mancuso and Leonardo Pantoni and Silvia Rosa and Pierluigi Bertora and Silvia Galliazzo and Walter Ageno and Elisabetta Toso and Filippo Angelini and Alberto Chiti and Giovanni Orlandi and Licia Denti and Yuriy Flomin and Simona Marcheselli and Nicola Mumoli and Alexandra Rimoldi and Elena Verrengia and Erika Schirinzi and {Del Sette}, Massimo and Panagiotis Papamichalis and Apostolos Komnos and Nemanja Popovic and Marija Zarkov and Alessandro Rocco and Marina Diomedi and Elisa Giorli and Alfonso Ciccone and {Mac Grory}, {Brian C.} and Furie, {Karen L.} and Bruno Bonetti and Valentina Saia and Francesca Guideri and Maurizio Acampa and Giuseppe Martini and Elisa Grifoni and Marina Padroni and Efstathia Karagkiozi and Kalliopi Perlepe and Konstantinos Makaritsis and Marina Mannino and Miriam Maccarrone and Leonardo Ulivi and Nicola Giannini and Elena Ferrari and Alessandro Pezzini and Boris Doronin and Vera Volodina and Antonio Baldi and Cataldo D'Amore and Dirk Deleu and Francesco Corea and Jukka Putaala and Paola Santalucia and Katiuscia Nardi and Angela Risitano and Danilo Toni and Georgios Tsivgoulis",
year = "2019",
month = "8",
day = "1",
doi = "10.1161/STROKEAHA.119.025350",
language = "English",
volume = "50",
pages = "2168--2174",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "8",

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TY - JOUR

T1 - Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Caso, Valeria

AU - Silvestrelli, Giorgio

AU - Seiffge, David Julian

AU - Engelter, Stefan

AU - De Marchis, Gian Marco

AU - Polymeris, Alexandros

AU - Zedde, Maria Luisa

AU - Yaghi, Shadi

AU - Michel, Patrik

AU - Eskandari, Ashraf

AU - Antonenko, Kateryna

AU - Sohn, Sung Il

AU - Cappellari, Manuel

AU - Tassinari, Tiziana

AU - Tassi, Rossana

AU - Masotti, Luca

AU - Katsanos, Aristeidis H.

AU - Giannopoulos, Sotirios

AU - Acciarresi, Monica

AU - Alberti, Andrea

AU - Venti, Michele

AU - Mosconi, Maria Giulia

AU - Vedovati, Maria Cristina

AU - Pierini, Patrizia

AU - Giustozzi, Michela

AU - Lotti, Enrico Maria

AU - Ntaios, George

AU - Kargiotis, Odysseas

AU - Monaco, Serena

AU - Lochner, Piergiorgio

AU - Bandini, Fabio

AU - Liantinioti, Chrysoula

AU - Palaiodimou, Lina

AU - Abdul-Rahim, Azmil H.

AU - Lees, Kennedy

AU - Mancuso, Michelangelo

AU - Pantoni, Leonardo

AU - Rosa, Silvia

AU - Bertora, Pierluigi

AU - Galliazzo, Silvia

AU - Ageno, Walter

AU - Toso, Elisabetta

AU - Angelini, Filippo

AU - Chiti, Alberto

AU - Orlandi, Giovanni

AU - Denti, Licia

AU - Flomin, Yuriy

AU - Marcheselli, Simona

AU - Mumoli, Nicola

AU - Rimoldi, Alexandra

AU - Verrengia, Elena

AU - Schirinzi, Erika

AU - Del Sette, Massimo

AU - Papamichalis, Panagiotis

AU - Komnos, Apostolos

AU - Popovic, Nemanja

AU - Zarkov, Marija

AU - Rocco, Alessandro

AU - Diomedi, Marina

AU - Giorli, Elisa

AU - Ciccone, Alfonso

AU - Mac Grory, Brian C.

AU - Furie, Karen L.

AU - Bonetti, Bruno

AU - Saia, Valentina

AU - Guideri, Francesca

AU - Acampa, Maurizio

AU - Martini, Giuseppe

AU - Grifoni, Elisa

AU - Padroni, Marina

AU - Karagkiozi, Efstathia

AU - Perlepe, Kalliopi

AU - Makaritsis, Konstantinos

AU - Mannino, Marina

AU - Maccarrone, Miriam

AU - Ulivi, Leonardo

AU - Giannini, Nicola

AU - Ferrari, Elena

AU - Pezzini, Alessandro

AU - Doronin, Boris

AU - Volodina, Vera

AU - Baldi, Antonio

AU - D'Amore, Cataldo

AU - Deleu, Dirk

AU - Corea, Francesco

AU - Putaala, Jukka

AU - Santalucia, Paola

AU - Nardi, Katiuscia

AU - Risitano, Angela

AU - Toni, Danilo

AU - Tsivgoulis, Georgios

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background and Purpose- Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non-vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods- Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results- Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95-5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63-9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83-3.16), and CHA2DS2-VASc score (OR, 1.72 for each point increase; 95% CI, 1.58-1.88) were associated with ischemic events. Among the CHA2DS2-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33-0.61). Conclusions- In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA2DS2-VASc score were associated with increased risk of cerebrovascular events.

AB - Background and Purpose- Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non-vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods- Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results- Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95-5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63-9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83-3.16), and CHA2DS2-VASc score (OR, 1.72 for each point increase; 95% CI, 1.58-1.88) were associated with ischemic events. Among the CHA2DS2-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33-0.61). Conclusions- In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA2DS2-VASc score were associated with increased risk of cerebrovascular events.

KW - atrial fibrillation

KW - humans

KW - prevention and control

KW - risk factors

KW - stroke

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U2 - 10.1161/STROKEAHA.119.025350

DO - 10.1161/STROKEAHA.119.025350

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