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Characteristics of Ischemic Stroke Despite Oral Anticoagulant Use For Atrial Fibrillation

Published online by Cambridge University Press:  18 January 2024

Marie-Christine Dubé Open the ORCID record for Marie-Christine Dubé [Opens in a new window] ,
Célina Ducroux ,
Nicole Daneault ,
Yan Deschaintre ,
Grégory Jacquin Open the ORCID record for Grégory Jacquin [Opens in a new window] ,
Céline Odier ,
Christian Stapf ,
Alexandre Y. Poppe Open the ORCID record for Alexandre Y. Poppe [Opens in a new window] ,
Giovanni Romanelli  and
Laura C. Gioia
Marie-Christine Dubé
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
Célina Ducroux
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
Nicole Daneault
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
Yan Deschaintre
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
Grégory Jacquin
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
Céline Odier
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
Christian Stapf
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
Alexandre Y. Poppe
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
Giovanni Romanelli
Affiliation:
Department of Medicine (Cardiology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
Laura C. Gioia*
Affiliation:
Department of Neurosciences, Faculté de médecine, Université de Montréal, Montréal, QC, Canada Department of Medicine (Neurology), Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada Neurovascular Group, Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
*
Corresponding author: Laura C. Gioia; Email: laura.gioia.med@ssss.gouv.qc.ca
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Abstract:

Oral anticoagulation (OAC) prevents stroke in atrial fibrillation, yet a residual stroke risk remains. In this single-center retrospective analysis of acute ischemic stroke patients despite OAC, suboptimal OAC treatment is common (30%: inappropriate dosing (17%); patient non-adherence (13%)). Other causes of stroke included OAC interruption (14.5%), a competing stroke mechanism (11.0%), and undetermined breakthrough stroke in 44.5%. Overall, easily modifiable causes of ischemic stroke despite OAC are common. Accordingly, strategies to improve treatment compliance, including appropriate dosing along with guideline-based risk factor and periprocedural OAC management, should be emphasized to improve secondary stroke prevention in this patient population.

Résumé :

RÉSUMÉ :

Les accidents vasculaires cérébraux ischémiques et leurs caractéristiques, dans la fibrillation auriculaire, malgré l’anticoagulothérapie orale.

Les anticoagulants oraux (AO) visent à prévenir la survenue d’accidents vasculaires cérébraux (AVC) dans le contexte de la fibrillation auriculaire, mais il persiste un risque résiduel. Ainsi, dans une analyse rétrospective de dossiers de patients ayant subi un AVC ischémique aigu, malgré les AO, réalisée dans un centre de traitement, l’application sous-optimale de traitement par les AO s’est révélée chose courante (30 %; posologie inappropriée [17 %], non-observance thérapeutique [13 %]). Par ailleurs, il existe d’autres causes possibles d’AVC, notamment l’interruption de l’anticoagulothérapie orale (14,5 %), la présence concomitante de mécanismes d’AVC (11,0 %) et la survenue d’AVC d’origine inconnue (44,5 %). Pourtant, plusieurs causes d’AVC ischémique, malgré les AO, sont facilement modifiables. Aussi faudrait-il mettre l’accent sur des stratégies permettant d’améliorer l’observance thérapeutique, la prescription de régimes posologiques appropriés ainsi que la prise en charge de facteurs de risque et de l’anticoagulothérapie orale en phase péri-interventionnelle, fondée sur des lignes directrices, dans le but rendre plus efficace la prévention secondaire des AVC dans ce groupe particulier de patients.

Keywords

Acute strokeanticoagulationtreatment failure
Type
Brief Communication
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 4
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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Footnotes

a

Marie-Christine Dubé and Célina Ducroux are equally contributed to the manuscript.

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