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Abstract Details

The “Natural History” of Stroke secondary to Atrial Fibrillation: two weeks without therapeutic anticoagulation.
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
4-003
The annual risk of recurrent ischemic stroke (RIS) and hemorrhagic transformation (HT) in Atrial Fibrillation (AF) is illustrated by the CHA2DS2VASc and HASBLED scores, respectively. However, the risk of any recurrent cerebral events in the subacute (two-week) phase after initial AF-stroke is unknown, and may represent the peak of the entire annual risk.

Our study investigated the “natural history” of cerebral events within the first two weeks after AF-related stroke or TIA, without therapeutic anticoagulation.

The AREST study (Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation) was a multi-centered randomized controlled trial exploring the effect of early anticoagulation with apixaban (n=41) versus warfarin (n=47) in patients with AF and stroke/TIA between 2015 and 2019. We performed a subgroup analysis of the warfarin arm who: 1) by two weeks had not yet started anticoagulation, or were subtherapeutic (INR< 2); and 2) received brain MRI at 14 +/- 3 days. 

Among 18 patients who met above criteria, 1 had TIA, 2 had RIS, and 2 developed HT. Of these 5 events, only 2 were detected clinically (40%), whereas the remaining 3 (60%) were asymptomatic but with MRI identified 1 RIS and 2 HT. Initial NIHSS was low (0 and 1) in both RIS patients but high in both HT patients (10 and 13). One of the RIS patients initially had TIA and later had MRI-detected right frontal infarct, the other patient initially had a left hemispheric multifocal infarct and later developed bilateral emboli. Both HT were in the initial infarct bed and were PH1 and HI1.

A majority of recurrent cerebral events within the two-week time period after AF-related stroke/TIA are clinically asymptomatic and only detected radiographically. Tools designed for annual risk estimation may underestimate risk of RIS and/or HT during the two-week subacute phase.

Authors/Disclosures
Xiyan Yi, MD (Sanford USD Medical center)
PRESENTER
Dr. Yi has nothing to disclose.
David Z. Rose, MD (USF) Dr. Rose has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Chiesi USA. Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Boehringer Ingelheim . Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL-Behring .
Arthur J Labovitz No disclosure on file
Michael G Fradley No disclosure on file
Nhi Tran Nhi Tran has nothing to disclose.
William Scott Burgin, MD Dr. Burgin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for VuEssence. Dr. Burgin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Burgin has stock in VuEssence. The institution of Dr. Burgin has received research support from VuEssence. The institution of Dr. Burgin has received research support from Bristol-Myers Squibb. The institution of Dr. Burgin has received research support from ReNeuron.
Swetha Renati, MD (University of South Florida) Dr. Renati has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ischemia View. Dr. Renati has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Renati has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Wettermark Keith, LLC. Dr. Renati has received personal compensation in the range of $500-$4,999 for serving as a Moderator with PRIME Education.