Highlights
- •RAFFINE is one of the largest cohorts of Japanese patients with atrial fibrillation.
- •Stroke and major bleeding occurred more often in the secondary prevention group.
- •Prior stroke/TIA was an independent predictor of stroke/systemic embolism.
Abstract
Objectives
Clinical outcome data of primary and secondary prevention in patients with nonvalvular
atrial fibrillation (NVAF) after the introduction of direct oral anticoagulant (DOAC)
therapy are limited.
Materials and Methods
A subgroup analysis of the RAFFINE registry, an observational, multicenter, prospective
registry of Japanese patients with AF, was performed. Incidence rates of stroke or
systemic embolism, all-cause death, major bleeding, and intracranial hemorrhage were
compared between patients with and without a history of stroke or transient ischemic
attack (TIA).
Results
Of 3,706 NVAF patients at baseline, 557 (15.0%) had a history of ischemic stroke or
TIA (secondary prevention group), and 3,149 (85.0%) had no history of ischemic stroke
or TIA (primary prevention group). The proportion of patients receiving oral anticoagulants
was 87.2% (42.5% warfarin, 44.7% DOACs). The secondary prevention group had higher
rates of stroke or systemic embolism (2.6% vs 1.0%/year, p<0.001), all-cause death
(3.6% vs 2.4%/year, p<0.01), and major bleeding (2.0% vs 1.3%/year, p<0.01), and similar
rates of intracranial hemorrhage (0.6% vs 0.5%/year, p=0.66) compared with the primary
prevention group. A Cox proportional hazards model showed that a history of ischemic
stroke or TIA was independently associated with an increased risk of stroke or systemic
embolism (adjusted hazard ratio, 2.22; 95% confidence interval, 1.57 – 3.15; p<0.001).
Conclusions
In a contemporary cohort of NVAF patients, a history of ischemic stroke or TIA was
still an independent predictor of stroke or systemic embolism, despite advances in
anticoagulation therapy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke.J Neurol Neurosurg Psychiatry. 2005; 76: 679-683
- Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination.Int J Cardiol. 2009; 137: 102-107
- High prevalence of atrial fibrillation among patients with ischemic stroke.Stroke. 2014; 45: 2599-2605
- Secondary prevention of stroke with warfarin in patients with nonvalvular atrial fibrillation: subanalysis of the J-RHYTHM registry.J Stroke Cerebrovasc Dis. 2016; 25: 585-599
- Secondary versus primary stroke prevention in atrial fibrillation: insights from the Darlington atrial fibrillation registry.Stroke. 2017; 48: 2198-2205
- Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.Ann Intern Med. 2007; 146: 857-867
- Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry.PLoS One. 2013; 8: e63479
- The use of anticoagulants in the management of atrial fibrillation among general practices in England.Heart. 2013; 99: 1166-1172
- Dabigatran versus warfarin in patients with atrial fibrillation.N Engl J Med. 2009; 361: 1139-1151
- Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.N Engl J Med. 2011; 365: 883-891
- Apixaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2011; 365: 981-992
- Edoxaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2013; 369: 2093-2104
- Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial.Lancet Neurol. 2010; 9: 1157-1163
- Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF.Lancet Neurol. 2012; 11: 315-322
- Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of the ARISTOTLE trial.Lancet Neurol. 2012; 11: 503-511
- Outcomes with edoxaban versus warfarin in patients with previous cerebrovascular events: findings from ENGAGE AF-TIMI 48 (effective anticoagulation with factor Xa next generation in atrial fibrillation-thrombolysis in myocardial infarction 48).Stroke. 2016; 47: 2075-2082
- Registry of Japanese patients with atrial fibrillation focused on anticoagulant therapy in the new era: the RAFFINE registry study design and baseline characteristics.J Cardiol. 2018; 71: 590-596
- Trends of anticoagulant use and outcomes in patients with non-valvular atrial fibrillation: findings from the RAFFINE registry.J Cardiol. 2022; 80: 41-48
- An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 2064-2089
- Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation.JAMA. 2001; 285: 2864-2870
- 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.Chest. 2010; 137: 263-272
- A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the EURO Heart Survey.Chest. 2010; 138: 1093-1100
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.J Thromb Haemost. 2005; 3: 692-694
- Prior stroke and transient ischemic attack as risk factors for subsequent stroke in atrial fibrillation patients: a report from the GARFIELD-AF registry.Int J Stroke. 2020; 15: 308-317
- Clinical features and prognosis in patients with atrial fibrillation and prior stroke: comparing the Fushimi and Darlington AF Registries.EBioMedicine. 2017; 18: 199-203
- Current status and outcomes of direct oral anticoagulant use in real-world atrial fibrillation patients- Fushimi AF Registry.Circ J. 2017; 81: 1278-1285
- Impact of previous stroke on clinical outcome in elderly patients with nonvalvular atrial fibrillation: ANAFIE Registry.Stroke. 2022; 53: 2549-2558
- Ischemic stroke despite oral anticoagulant therapy in patients with atrial fibrillation.Ann Neurol. 2020; 87: 677-687
- Recurrent ischemic stroke and bleeding in patients with atrial fibrillation who suffered an acute stroke while on treatment with nonvitamin K antagonist oral anticoagulants: the RENO-EXTEND Study.Stroke. 2022; 53: 2620-2627
- Intensity of anticoagulation and clinical outcomes in acute cardioembolic stroke: the Fukuoka Stroke Registry.Stroke. 2013; 44: 3239-3242
- Adequate adherence to direct oral anticoagulant is associated with reduced ischemic stroke severity in patients with atrial fibrillation.J Stroke Cerebrovasc Dis. 2019; 28: 1773-1780
Article info
Publication history
Published online: November 07, 2022
Accepted:
October 31,
2022
Received in revised form:
October 19,
2022
Received:
August 13,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106871
Copyright
© 2022 Elsevier Inc. All rights reserved.