Page 118 - AN-3-1

Advanced Neurology

SHORT COMMUNICATION
Subclinical atrial fibrillation in embolic stroke of

undetermined source: Management and stroke
recurrence

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Luca Masotti *, Elisa Grifoni , Alessia Baglini , Teresa Sansone ,
Mariella Baldini , Sara Giannoni , Elisabetta Bertini , Ilaria Di Donato ,
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Irene Sivieri , Marianna Mannini , Gina Iandoli , Ira Signorini ,
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Eleonora Cosentino , Irene Micheletti , Elisa Cioni , Giulia Pelagalli ,
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Elisa Giglio , Eleonora Brai , Alessandro Dei , Antonio Giordano ,
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Francesca Dainelli , Mario Romagnoli , Chiara Mattaliano , Elena Schipani ,
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Giuseppe Salvatore Murgida , Stefania Di Martino , and Valentina Francolini 1
1 Internal Medicine II and Stroke Unit, San Giuseppe Hospital, Empoli, Italy
2 Neurology, San Giuseppe Hospital, Empoli, Italy
(This article belongs to Special Issue: Advances in stroke research and therapy)
Abstract
Subclinical atrial fibrillation (SAF) represents the most prevalent underlying etiology
detected after an embolic stroke of undetermined source (ESUS). Investigating
SAF is strongly recommended during the diagnostic work-up. The efficacy of oral
anticoagulant (OAC) therapy in reducing the risk of stroke recurrence post-SAF
*Corresponding author:
Luca Masotti detection remains a conundrum. Thus, our study aimed to analyze the management
(luca.masotti@tin.it) of secondary antithrombotic prophylaxis and the rate of 12-month stroke recurrence
Citation: Masotti L, Grifoni E, in real-life ESUS patients. We retrospectively analyzed clinical, radiographic,
Baglini A, Sansone T, Baldini M, and echocardiographic findings of patients with ESUS who underwent non-
Giannoni S, et al. Subclinical atrial implantable 2-week electrocardiogram (ECG) monitoring after discharge. Episodes
fibrillation in embolic stroke of
undetermined source: Management of SAF of any duration were considered diagnostic. Antithrombotic treatment at
and stroke recurrence. Adv Neuro. hospital discharge and after ECG monitoring, as well as 12-month recurrence, were
2024;3(1):2287. registered. We compared the rate of stroke recurrence between patients with and
https://doi.org/10.36922/an.2287
without detection of SAF. One hundred and fifty-nine patients (75 females) with a
Received: November 21, 2023 median age of 73.5 (interquartile range [IQR] = 66.75 – 79) years represented the study
Accepted: January 19, 2024 population. At hospital discharge, 96.9% of patients received antiplatelet therapy
as secondary antithrombotic prophylaxis. SAF was detected in 82 patients (51.5%),
Published Online: March 20, 2024
and OAC was prescribed in 98.6% of them. The median time from stroke onset to
Copyright: © 2024 Author(s). OAC prescription was 143 (IQR = 94 – 178) days. Overall, 12-month stroke recurrence
This is an Open-Access article occurred in eight patients (5%). The stroke recurrence rate was lower in patients
distributed under the terms of the
Creative Commons Attribution prescribed OAC compared with those not prescribed it, although the difference
License, permitting distribution, was not significant (3.7% vs. 6.25%; P = 0.7202). In our study, OACs prescribed post-
and reproduction in any medium, SAF detection in patients with ESUS reduced, but not significantly, the risk of stroke
provided the original work is
properly cited. recurrence. Future research and prospective multicenter studies are warranted.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Atrial fibrillation; Stroke; Embolic stroke of undetermined source; Score;
regard to jurisdictional claims in
published maps and institutional Electrocardiogram monitoring; Oral anticoagulants; Recurrence
affiliations.
Volume 3 Issue 1 (2024) 1 https://doi.org/10.36922/an.2287