Hemorrhagic stroke related to increased mortality and disability in patients with AF

Hemorrhagic Strokes in Patients With Atrial Fibrilliation: The Neuro-AFib Study

Presented at the International Stroke Conference 2021 by Edip Gurol (Boston, MA, USA)

Introduction and methods

There is little information about the frequency and causes of ischemic strokes (IS) and hemorrhagic strokes (HS) in patients with AF. The neuro-AFib study is an ongoing multicentered study that focuses on causes and mechanisms of IS and HS and the current management and long-term outcomes in patients with AF. The investigator sponsored research study is conducted in 25 stroke/neurology departments in North America and has enrolled a total of ~10,000 patients in retrospective and prospective phases over 5 years. The retrospective study presented here, analyzed the frequency and failures in the prevention of acute IS of HS in patients with AF (n=6195) who were admitted to the hospital (16 sites) with an acute stroke (IS or HS) from January 2018 to December 2019.

Main results

• Of all AF patients who experienced an IS (n=5153, 83.2%), 77% was previously diagnosed with AF and 46% were treated with an OAC (DOAC 58%, warfarin 40%, heparin 2%). 28% Of these patients were only on antiplatelet therapy and 26% received no antithrombotic treatment.

• 23% Of patients who suffered from an IS were diagnosed with new-onset AF during hospital admission. Of these cases, 10% was already on OAC treatment for AF non-related illnesses, 38% received anti-platelet therapy and 52% were not on antithrombotics.

• Of all AF patients who experienced an HS (n=1042, 16.8%), 82% were previously diagnosed with AF and 71% had OAC therapy (DOAC 54%, warfarin 45%, heparin 1%), 13% anti-platelet, and 16% were not on antithrombotics. The other 18% were diagnosed with AF during their hospitalization with 15% of patients receiving OAC treatment before the HS.

• In general, AF patients who suffered an HS had a more severe outcome and were longer hospitalized compared to patients with an IS (NIHSS: 12±10 vs. 10.4±9; length hospitalization: 9.3±9 days vs. 7.4±7 days, all P<0.001).

• The death/disability rate at discharge as well as in-hospital deaths were higher in patients with an HS compared to those who had an IS (death/disability at discharge: 76% vs. 57%; in-hospital death: 38% vs. 11.7%, all P<0.001).

• Approximately 37% of all AF-related IS cases were due to OAC-treatment failure. DOAC failures were 50% more common than warfarin failures. Other major contributors to AF-related IS were failure to detect AF (23%) or use FDA-approved prevention measures (~40%). In patients with AF and HS, DOAC-related intracerebral hemorrhages were 20% more common than warfarin-related intracerebral hemorrhages.

Conclusion

These preliminary results from the Neuro-AFib study showed significantly worse outcomes for HS compared to IS in patients with AF. In-hospital case fatality with HS was ~3.5 times higher compared to IS and these patients had an increased risk for a severe disability.

– Our reporting is based on the information provided during ISC 2021 –