Abstract T P58: Early Anticoagulant Therapy for Secondary Stroke Prevention in Japanese NVAF Patients With TIA/minor Stroke: The SAMURAI-NVAF Study
Objective: Early anticoagulant therapy is commonly used for acute cardioembolic stroke in Japan, although its usefulness remains undetected. The purpose of this study was to estimate the efficacy and safety of early anticoagulation for the treatment of acute stroke/TIA patients with nonvalvular atrial fibrillation (NVAF).
Methods: From September 2011 through June 2013, 697 acute ischemic stroke/TIA patients with NVAF were registered from a multicenter prospective registry (the SAMURAI-NVAF study including 18 Japanese stroke centers, NCT01581502). Of those, the patients who started anticoagulant therapy within 48 hours after the onset were assessed for the incidence of ischemic and hemorrhagic events during the first 30 days.
Results: A total of 438 patients (62.8%; 247 men, 77.4±9.8 years old) was evaluated. Of these, 292 patients (66.7%) started anticoagulation with intravenous unfractionated heparin (UFH) mono-therapy, 87 patients (19.9%) with UFH and warfarin, and 2 patients (0.5%) with UFH switched to novel oral anticoagulants (NOACs). As oral anticoagulants mono-therapy, 34 patients (7.8%) started with warfarin, and 23 (5.3%) with NOAC. Ischemic events were developed in 11 patients (2.5%: 11 recurrent ischemic strokes), and hemorrhagic events in 11 patients (2.5%: 6 symptomatic intracranial hemorrhages during the first 7days and 5 extracranial hemorrhages). Patients with major artery occlusion had higher incidence of hemorrhagic events than those without (4.0% versus 0.6%, p=0.02), whereas ischemic events were similar in both groups (2.4% versus 2.7%, p=0.82). In multivariable analysis, major artery occlusion was independently associated with higher rate of major hemorrhagic events (OR 6.19; 95% CI 1.01-119.75) adjusted for age, sex, BMI, HAS-BLED score before index TIA/stroke, and NIHSS on admission.
Conclusion: In our cohort, early initiation of anticoagulant therapy is often performed in patients with acute stroke/TIA with NVAF patient, and the frequency of ischemic and hemorrhagic events seems to be low compared with previous reports. Early anticoagulant therapy can be safe for patients without major artery occlusion.
Author Disclosures: N. Kinoshita: None. H. Yamagami: Research Grant; Significant; Grants-in-Aid from the Ministry of Health, Labour and Welfare of Japan. Honoraria; Modest; Boehringer Ingelheim, Bayer. S. Arihiro: None. M. Koga: None. S. Sato: None. K. Todo: None. K. Kimura: None. Y. Shiokawa: None. K. Kamiyama: None. T. Terasaki: None. Y. Okada: None. Y. Nagakane: None. E. Furui: None. Y. Ito: None. T. Nakashima: None. K. Kario: None. T. Kameda: None. K. Takamatsu: None. K. Takamatsu: None. K. Takamatsu: None. K. Takamatsu: None. K. Nagatsuka: None. K. Toyoda: Research Grant; Significant; Grants-in-Aid from the Ministry of Health, Labour and Welfare of Japan. Honoraria; Modest; Boehringer Ingelheim, Bayer.
- © 2014 by American Heart Association, Inc.