{"id":"521e364f64ca","type":"article","url":"https://hartvaat.nl/2023/05/21/prognose-van-ischemisch-cva-onder-orale-anticoagulatie-bij-af/","title":"Prognose van ischemisch CVA onder orale anticoagulatie bij AF","title_en":"Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad200","source_url":"https://doi.org/10.1093/eurheartj/ehad200","authors":["Alexander P Benz","Stefan H Hohnloser","John W Eikelboom","Anthony P Carnicelli","Robert P Giugliano","Christopher B Granger","Josephine Harrington","Ziad Hijazi","David A Morrow","Manesh R Patel","David J Seiffge","Ashkan Shoamanesh","Lars Wallentin","Qilong Yi","Stuart J Connolly"],"significance":7,"published":"2023-05-21","source_date":"2023-05-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This study characterized the outcomes of AF patients who suffer ischemic stroke despite oral anticoagulation, showing poor prognosis and highlighting the residual stroke risk that persists even with guideline-directed anticoagulation.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T13:29:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de uitkomsten van AF-patiënten die een ischemisch CVA kregen ondanks orale anticoagulatie. De prognose was somber met hoge recidief- en mortaliteitscijfers. Intensivering van antistolling na doorbraak-CVA verbeterde de uitkomsten niet consistent.","abstract_original":"AIMS: The prognosis of patients with atrial fibrillation (AF) and ischemic stroke while taking oral anticoagulation is poorly understood. This study aimed to characterize the outcomes of patients following a stroke event while on oral anticoagulation. METHODS AND RESULTS: Individual participant data from five pivotal randomized trials of antithrombotic therapy in AF were used to assess the outcomes of patients with a post-randomization ischemic stroke while on study medication (warfarin, standard-, or lower-dose direct oral anticoagulant regimen) during trial follow-up. The primary outcome was recurrent ischemic stroke after the first post-randomization ischemic stroke. The primary analysis included 1163 patients with a first post-randomization ischemic stroke while on study medication (median age 73 years, 39.3% female, 35.4% history of stroke before trial enrollment). During a median continued follow-up of 337 days, 74 patients had a recurrent ischemic stroke [cumulative incidence at 1 year: 7.0%, 95% confidence interval (CI) 5.2%-8.7%]. The cumulative incidence of mortality at 3 months after stroke was 12.4% (95% CI 10.5%-14.4%). Consistent results for the incidence of recurrent ischemic stroke at 1 year were obtained in an analysis accounting for the competing risk of death (6.2%, 95% CI 4.8%-7.9%) and in a landmark analysis excluding the first 2 weeks after the index stroke and only including patients without permanent study drug discontinuation since then (6.8%, 95% CI 4.6%-8.9%). CONCLUSION: Patients with AF and ischemic stroke while on oral anticoagulation are at increased risk of recurrent ischemic stroke and death. These patients currently have an unmet medical need."}