Sustained atrial fibrillation is a predictor of stroke severity in patients taking direct oral anticoagulants

By Samar Mahmoud, MS
Published February 2, 2022

Key Takeaways

  • This study found that, in comparison to paroxysmal atrial fibrillation (AF), sustained AF is associated with a higher stroke severity. 

  • Major vessel occlusion frequently accompanied sustained AF. 

  • Interventional studies are needed to determine whether rhythm control can prevent severe stroke.

AF is the most common cardiac arrhythmia and includes paroxysmal and sustained (persistent or permanent) AF. Both AF forms are risk factors for ischemic stroke.

Why This Study Matters

The association between the different forms of AF and the risk of stroke has been evaluated in multiple studies with contradictory results. As a result, the link between AF patterns and stroke severity remains unclear. To fill this gap, this study sought to investigate the differences in stroke severity upon hospital admission between patients presenting with paroxysmal and sustained AF.

Study Design

Investigators used data from 300 nonvalvular patients with AF and acute anterior circulation stroke who were enrolled in the Multicenter Prospective Analysis of Stroke Patients Taking Oral Anticoagulants study. Participants were treated with direct oral anticoagulants (DOACs). 

Investigators divided study participants into two groups: paroxysmal AF; and sustained AF. The effect of the two types of AF on stroke severity on admission was evaluated. 

Results and Conclusions

Of the 300 patients enrolled in the study, 246 (males, median age 80 years) and 54 (males, median age 78 years) were assigned to the sustained AF and paroxysmal AF groups, respectively. Compared to the paroxysmal AF group, the sustained AF group had a higher proportion of severe stroke (22.0% vs 5.7%) and internal carotid artery occlusion (11.4% vs 1.9%). After adjusting for multiple variables, investigators found that sustained AF was significantly associated with severe stroke on admission (odds ratio 4.54). 

Related Research

Consider these findings from similar research studies:

  • Compared to paroxysmal AF, sustained AF was not associated with a higher risk of ischemic stroke recurrence (Source). 

  • Compared to traditional approaches, early rhythm-control therapy was associated with lower risk of adverse cardiovascular outcomes in patients with AF (Source). 

Original Source 

Hayashi T, Suda S, Abe A, et al. Sustained atrial fibrillation is related to a higher severity of stroke in patients taking direct oral anticoagulants. Journal of the Neurological Sciences.

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