Discontinuing OAC associated with heightened risk of recurrent stroke, study finds
Among patients with atrial fibrillation prescribed oral anticoagulation (OAC) after a stroke, recurrent stroke rates were 13.4% versus 6.8% in those who did and did not discontinue OAC therapy, a Danish study found.
Patients with atrial fibrillation and a previous stroke despite secondary prevention with oral anticoagulation (OAC), a study found, and discontinuation doubled the risk of recurrent IS compared with patients who continued OAC.
The nationwide cohort study included all Danish patients with atrial fibrillation who started or restarted OAC within 30 days of stroke discharge from January 2014 to December 2021 (n=8,119). Patients were followed for recurrent stroke until June 2022. Researchers also conducted a nested case-control analysis matching patients with recurrent stroke to patients receiving OAC who did not. Results were published June 24 in JAMA Neurology.
Over a mean follow-up of 2.9 years, 663 patients had a recurrent stroke, of whom 533 (80.4%) were receiving OAC at the time of their stroke. The crude cumulative incidence of recurrence at 1 year was 4.3% (95% CI, 5.9% to 7.1%). The crude cumulative incidence of all-cause mortality was 15.4% (95% CI, 14.7% to 16.2%). Patients who discontinued OACs had a higher risk of recurrent stroke (89 cases [13.4%] vs. 180 controls [6.8%]; adjusted odds ratio, 2.13 [95% CI, 1.57 to 2.89]) compared with patients still receiving OAC.
The study highlights the importance of continuing OACs and the need for improved secondary stroke prevention in patients with atrial fibrillation, with prevention strategies such as left atrial appendage occlusion with or without continuous direct oral anticoagulants in high-risk populations, according to the study authors.
The additional finding that patients who discontinued OAC had more severe strokes and higher mortality rates are consistent with previous observational studies and "underlines the importance of treatment with OACs not only to prevent [ischemic stroke] IS but also to reduce stroke severity and improve outcomes and survival in patients with [atrial fibrillation] having an IS."