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Dabigatran Initiation in Patients with Non-Valvular AF and First Acute Ischaemic Stroke: a Retrospective Observational Study from the SITS Registry

2020Journal article Open access
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dc.contributor.authorEscudero-Martinez, I
dc.contributor.authorMazya, M
dc.contributor.authorTeutsch, C
dc.contributor.authorLesko, N
dc.contributor.authorGdovinova, Z
dc.contributor.authorBarbarini, L
dc.contributor.authorFryze, W
dc.contributor.authorKarlinski, M
dc.contributor.authorKobayashi, A
dc.contributor.authorKrastev, G
dc.contributor.authorPaiva Nunes, A
dc.contributor.authorPasztoova, K
dc.contributor.authorPeeters, A
dc.contributor.authorSobolewski, P
dc.contributor.authorVilionskis, A
dc.contributor.authorToni, D
dc.contributor.authorAhmed, N
dc.date.accessioned2021-07-15T14:43:00Z
dc.date.available2021-07-15T14:43:00Z
dc.date.issued2020
dc.description.abstractBackground and objective: The optimal timing for initiation of dabigatran after acute ischaemic stroke (AIS) is not established. We aimed to evaluate initiation timing and clinical outcomes of dabigatran in AIS patients with non-valvular atrial fibrillation (NVAF). Design: Retrospective study based on prospectively collected data in SITS (Safe Implementation of Treatment in Stroke) Thrombolysis and Thrombectomy Registry from July 2014 to July 2018. Participants: European NVAF patients (≥18 years) hospitalised after first-ever ischaemic stroke. Setting: A multinational, observational monitoring register. Intervention: Dabigatran initiation within 3 months after the ischaemic stroke. Primary and secondary outcomes: The primary outcome was time from first-ever ischaemic stroke (index event) to dabigatran initiation. Additional outcomes included physicians' reasons for delaying dabigatran initiation beyond acute hospital discharge and outcomes within 3 months of index event. Methods: We identified patients with NVAF who received dabigatran within 3 months of the index event. We performed descriptive statistics for baseline and demographic data and clinical outcomes after dabigatran initiation. Results: In total, 1489 patients with NVAF received dabigatran after AIS treated with thrombolysis and/or thrombectomy. Of these, 1240 had available initiation time. At baseline, median age was 75 years; 53% of patients were women, 15% were receiving an oral anticoagulant, 29% acetylsalicylic acid and 4% clopidogrel. Most patients (82%) initiated dabigatran within 14 days after the index event. Patients initiating earlier had lower stroke severity from median NIHSS 8 (IQR 6-13) if initiated within 7 days to NIHSS 15 (9-19) if initiated between 28 days and 3 months. Most common reasons for delaying initiation were haemorrhagic transformation or intracranial haemorrhage, stroke severity and infarct size. Few thrombotic/haemorrhagic events occurred within 3 months after the index event (20 of 926 patients, 2.2% with the available data). Conclusions: Our findings, together with previous observational studies, indicate that dabigatran initiated within the first days after an AIS is safe in patients treated with intravenous thrombolysis, endovascular thrombectomy or both.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationBMJ Open. 2020 May 19;10(5):e037234.pt_PT
dc.identifier.doi10.1136/bmjopen-2020-037234pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3766
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMJpt_PT
dc.relationNCT03258645pt_PT
dc.subjectAgedpt_PT
dc.subjectAnticoagulantspt_PT
dc.subjectDabigatranpt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectMalept_PT
dc.subjectRegistriespt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectAtrial Fibrillationpt_PT
dc.subjectBrain Ischemiapt_PT
dc.subjectIschemic Strokept_PT
dc.subjectStrokept_PT
dc.subjectHSJ NEUpt_PT
dc.titleDabigatran Initiation in Patients with Non-Valvular AF and First Acute Ischaemic Stroke: a Retrospective Observational Study from the SITS Registrypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue5pt_PT
oaire.citation.startPagee037234pt_PT
oaire.citation.titleBMJ Openpt_PT
oaire.citation.volume10pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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