New Research Could Prove Beneficial For AFib Patients at Risk of Stroke

Four separate studies presented Aug. 27 as part of ESC Congress 2016 in Rome could prove beneficial for treating patients with atrial fibrillation (AFib) who are at risk for ischemic stroke.

In one study, alcohol-related hospitalization was associated with a doubled risk of ischemic stroke in low-risk patients with non-valvular atrial AFib. The retrospective study looked at 25,252 low-risk, non-valvular AFib patients between the ages of 18–64 (median age 55) identified from the Swedish nationwide patient registry between Jan. 1, 2006 and Dec. 31, 2012. A multivariable analysis showed age and alcohol-related hospitalization as the only variables significantly associated with an increased risk of ischemic stroke. The use of oral anticoagulants was associated with a lower risk of ischemic stroke.

“Previous studies have shown a causal and dose-response relation between alcohol and AFib,” said Faris Al-Khalili, MD, of Karolinska Institute, Danderyd Hospital in Stockholm, Sweden. “Our study found that alcohol is an independent risk factor for stroke in patients with AFib. … Doctors should ask their AFib patients about alcohol use and advise patients to cut down if they are drinking more than is recommended.”

Meanwhile, another study out of Denmark found that new oral anticoagulants (NOACs) offer the same stroke prevention as warfarin but cause less intracranial bleeding. The study of more than 43,000 patients compared the risk of stroke and intracranial bleeding with NOACs (dabigatran, rivaroxaban and apixaban) vs. warfarin in a ‘real world’ setting. Researchers found that the risk of having a stroke within one year was similar between the NOAC and warfarin groups, and ranged from 2.0 percent to 2.5 percent. At one year the risk of intracranial bleeding was significantly lower in patients treated with dabigatran and apixaban (0.3 percent to 0.4 percent) compared to those treated with warfarin (0.6 percent.

A third study tested the use of smartphones to detect AFib using the phone’s own accelerometer and gyroscope. “We used the accelerometer and gyroscope of the smartphone to acquire a heart signal from the patient,” said Tero Koivisto, a vice-director of the Technology Research Centre at the University of Turku, Finland. “This is a low cost, non-invasive way to detect AFib that people can do themselves without any help from medical staff. Given the widespread use of smartphones, it has the potential to be used by large populations worldwide. In the future, a secure cloud service could be created to store and analyse larger masses of data.”

Results from the observational PRAGUE-16 registry study found direct catheter-based thrombectomy to be equally effective to bridging thrombolysis in the treatment of acute ischemic stroke. Forty-one percent of patients who received direct catheter-based thrombectomy had good functional recovery. The results are similar to other randomized trials performed in expert neuroradiology units.

“Our findings suggest that direct catheter-based thrombectomy performed in a timely manner may be an alternative to thrombectomy after bridging thrombolysis,” said principal investigator Petr Widimsky, MD, FACC, head of the Third Faculty of Medicine, Charles University, Prague, Czech Republic.  “Furthermore, in regions with no (or limited) interventional neuroradiology services, modern stroke treatment might be offered via interventional cardiology services in close cooperation with neurologists and radiologists. However, both of these preliminary conclusions should be confirmed by larger multicenter studies or large international registries.”

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: ESC Congress, Alcohols, Anticoagulants, Atrial Fibrillation, Antithrombins, Hospitalization, Intracranial Hemorrhages, Pyrazoles, Pyridones, Randomized Controlled Trials as Topic, Registries, Research Personnel, Retrospective Studies, Risk Factors, Stroke, Thrombectomy, Universities, Warfarin

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