Antithrombotic treatment at onset of stroke with atrial fibrillation, functional outcome, and fatality: a systematic review and meta-analysis.

International Journal of Stroke

PubMedID: 25808552

Hannon N, Arsava EM, Audebert HJ, Ay H, Crowe M, Ní Chróinín D, Furie K, McGorrian C, Molshatzki N, Murphy S, Noone I, O'Donnell M, Schenkel J, Tan KM, Tanne D, Kelly PJ. Antithrombotic treatment at onset of stroke with atrial fibrillation, functional outcome, and fatality: a systematic review and meta-analysis. Int J Stroke. 2015;10(6):808-14.
BACKGROUND
In atrial fibrillation-associated stroke, conflicting data exist regarding association between therapeutic vitamin K-antagonist anticoagulation (International Normalized Ratio 2-3) and early death and functional outcome, and few data exist relating to late outcome in ischemic and haemorrhagic atrial fibrillation-stroke.

AIM
We performed a systematic review and meta-analysis of oral anticoagulation at stroke onset, death and functional outcome.

METHODS
We performed a systematic review, searching multiple sources. Studies were included if outcomes in atrial fibrillation-associated stroke were reported stratified by pre-stroke antithrombotic status, with documented International Normalized Ratio at onset. Outcomes were survival and good functional outcome (modified Rankin score 0-2) at discharge/30 days, and at one-year.

RESULTS
Of eight studies (3552 patients) in ischemic stroke, International Normalized Ratio?=?2 compared with other treatments (International Normalized Ratio?
CONCLUSIONS
Therapeutic International Normalized Ratio at stroke onset was associated with early and late improved survival and functional recovery suggesting sustained benefit for warfarin anticoagulation for stroke outcome in atrial fibrillation patients. Long-term outcome data following stroke in patients taking new oral anticoagulants is required.