Abstract
Original language | English |
---|---|
Pages (from-to) | 726-732 |
Number of pages | 7 |
Journal | Stroke |
Volume | 48 |
Issue number | 3 |
DOIs | |
Publication status | Published - 2017 |
Fingerprint
Keywords
- atrial fibrillation
- myocardial infarction
- risk stratification
- stroke
- anticoagulant agent
- warfarin
- aged
- anticoagulant therapy
- Article
- cardiovascular risk
- cerebrovascular accident
- computer assisted tomography
- early diagnosis
- early intervention
- female
- heart atrium enlargement
- human
- major clinical study
- male
- nuclear magnetic resonance
- observational study
- outcome assessment
- priority journal
- prospective study
- recurrence risk
- risk assessment
- thromboembolism
- transient ischemic attack
- transthoracic echocardiography
- bleeding
- chemically induced
- complication
- Ischemic Attack, Transient
- procedures
- recurrent disease
- Stroke
- very elderly
- Aged
- Aged, 80 and over
- Anticoagulants
- Atrial Fibrillation
- Female
- Hemorrhage
- Humans
- Male
- Prospective Studies
- Recurrence
- Risk Assessment
- Thromboembolism
- Warfarin
Cite this
Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study. / Paciaroni, M.; Agnelli, G.; Caso, V.; Tsivgoulis, G.; Furie, K.L.; Tadi, P.; Becattini, C.; Falocci, N.; Zedde, M.; Abdul-Rahim, A.H.; Lees, K.R.; Alberti, A.; Venti, M.; Acciarresi, M.; D'Amore, C.; Mosconi, M.G.; Cimini, L.A.; Procopio, A.; Bovi, P.; Carletti, M.; Rigatelli, A.; Cappellari, M.; Putaala, J.; Tomppo, L.; Tatlisumak, T.; Bandini, F.; Marcheselli, S.; Pezzini, A.; Poli, L.; Padovani, A.; Masotti, L.; Vannucchi, V.; Sohn, S.-I.; Lorenzini, G.; Tassi, R.; Guideri, F.; Acampa, M.; Martini, G.; Ntaios, G.; Karagkiozi, E.; Athanasakis, G.; Makaritsis, K.; Vadikolias, K.; Liantinioti, C.; Sacco, S.; Carolei, A.; Colombo, G.; Mancuso, M.; Maccarrone, M.; Chiti, A.
In: Stroke, Vol. 48, No. 3, 2017, p. 726-732.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study
AU - Paciaroni, M.
AU - Agnelli, G.
AU - Caso, V.
AU - Tsivgoulis, G.
AU - Furie, K.L.
AU - Tadi, P.
AU - Becattini, C.
AU - Falocci, N.
AU - Zedde, M.
AU - Abdul-Rahim, A.H.
AU - Lees, K.R.
AU - Alberti, A.
AU - Venti, M.
AU - Acciarresi, M.
AU - D'Amore, C.
AU - Mosconi, M.G.
AU - Cimini, L.A.
AU - Procopio, A.
AU - Bovi, P.
AU - Carletti, M.
AU - Rigatelli, A.
AU - Cappellari, M.
AU - Putaala, J.
AU - Tomppo, L.
AU - Tatlisumak, T.
AU - Bandini, F.
AU - Marcheselli, S.
AU - Pezzini, A.
AU - Poli, L.
AU - Padovani, A.
AU - Masotti, L.
AU - Vannucchi, V.
AU - Sohn, S.-I.
AU - Lorenzini, G.
AU - Tassi, R.
AU - Guideri, F.
AU - Acampa, M.
AU - Martini, G.
AU - Ntaios, G.
AU - Karagkiozi, E.
AU - Athanasakis, G.
AU - Makaritsis, K.
AU - Vadikolias, K.
AU - Liantinioti, C.
AU - Sacco, S.
AU - Carolei, A.
AU - Colombo, G.
AU - Mancuso, M.
AU - Maccarrone, M.
AU - Chiti, A.
N1 - Cited By :1 Export Date: 2 March 2018 CODEN: SJCCA Correspondence Address: Paciaroni, M.; Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, Italy; email: maurizio.paciaroni@unipg.it Chemicals/CAS: warfarin, 129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2; Anticoagulants; Warfarin References: Paciaroni, M., Agnelli, G., Falocci, N., Caso, V., Becattini, C., Marcheselli, S., Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: Effect of anticoagulation and its timing: The RAF study (2015) Stroke, 46, pp. 2175-2182; Paciaroni, M., Agnelli, G., Falocci, N., Caso, V., Becattini, C., Marcheselli, S., Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: Findings from the RAF study (2016) J Neurol., 263, pp. 231-237; Lang, R.M., Bierig, M., Devereux, R.B., Flachskampf, F.A., Foster, E., Pellikka, P.A., Recommendations for chamber quantification: A report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group developed in conjunction with the European Association of Echocardiography a branch of the European Society of Cardiology (2005) J Am Soc Echocardiogr., 18, pp. 1440-1463. , Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography; Fischer, U., Arnold, M., Nedeltchev, K., Brekenfeld, C., Ballinari, P., Remonda, L., NIHSS score and arteriographic findings in acute ischemic stroke (2005) Stroke, 36, pp. 2121-2125; Schulman, S., Kearon, C., Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients (2005) J Thromb Haemost., 3, pp. 692-694. , Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis; Strbian, D., Meretoja, A., Ahlhelm, F.J., Pitkäniemi, J., Lyrer, P., Kaste, M., Predicting outcome of IV thrombolysis-treated ischemic stroke patients: The DRAGON score (2012) Neurology., 78, pp. 427-432; Micheli, S., Agnelli, G., Caso, V., Paciaroni, M., Clinical benefit of early anticoagulation in cardioembolic stroke (2008) Cerebrovasc Dis., 25, pp. 289-296; Paciaroni, M., Agnelli, G., Ageno, W., Caso, V., Timing of anticoagulation therapy in patients with acute ischaemic stroke and atrial fibrillation (2016) Thromb Haemost., 116, pp. 410-416; Lip, G.Y., Nieuwlaat, R., Pisters, R., Lane, D.A., Crijns, H.J., Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The euro heart survey on atrial fibrillation (2010) Chest., 137, pp. 263-272
PY - 2017
Y1 - 2017
N2 - Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings. © 2017 American Heart Association, Inc.
AB - Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings. © 2017 American Heart Association, Inc.
KW - atrial fibrillation
KW - myocardial infarction
KW - risk stratification
KW - stroke
KW - anticoagulant agent
KW - warfarin
KW - aged
KW - anticoagulant therapy
KW - Article
KW - cardiovascular risk
KW - cerebrovascular accident
KW - computer assisted tomography
KW - early diagnosis
KW - early intervention
KW - female
KW - heart atrium enlargement
KW - human
KW - major clinical study
KW - male
KW - nuclear magnetic resonance
KW - observational study
KW - outcome assessment
KW - priority journal
KW - prospective study
KW - recurrence risk
KW - risk assessment
KW - thromboembolism
KW - transient ischemic attack
KW - transthoracic echocardiography
KW - bleeding
KW - chemically induced
KW - complication
KW - Ischemic Attack, Transient
KW - procedures
KW - recurrent disease
KW - Stroke
KW - very elderly
KW - Aged
KW - Aged, 80 and over
KW - Anticoagulants
KW - Atrial Fibrillation
KW - Female
KW - Hemorrhage
KW - Humans
KW - Male
KW - Prospective Studies
KW - Recurrence
KW - Risk Assessment
KW - Thromboembolism
KW - Warfarin
U2 - 10.1161/STROKEAHA.116.015770
DO - 10.1161/STROKEAHA.116.015770
M3 - Article
VL - 48
SP - 726
EP - 732
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 3
ER -