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Advanced Neurology ESUS, atrial fibrillation, and recurrence

by the “Comitato Etico Regionale per la Sperimentazione detected in one of these patients (20%) within the first
Clinica della Regione Toscana Sezione AREA VASTA 12 months, and DOAC was prescribed. Among the 82
CENTRO (protocol code: E2AF Study; protocol number patients in whom SAF was detected, OAC was prescribed
20487 of September 9, 2021). in 81 (98.6%; DOAC 96.2%, VKA 2.4%). Apixaban was
prescribed in 45 patients (57%), edoxaban in 20 (25%),
2.2. Statistical analysis rivaroxaban in 9 (11.5%), and dabigatran in 5 (11.5%).

Continuous variables were reported as median and In addition, in 21% of patients prescribed OAC, a single-
interquartile range (IQR) where appropriate. Categorical antiplatelet therapy was administered. The median time
variables were analyzed using the Chi-square or Fisher’s from stroke onset to OAC prescription was 143 (IQR = 94 –
exact tests as applicable. Multivariate logistic regression 178) days (Table 3).
analysis was used to identify the risk factors for stroke
th
recurrence, with odd ratios (OR) and their 95 percentile Table 1. Antithrombotic prevention at hospital discharge
confidence intervals (CI) reported. A P < 0.05 was Antithrombotic prophylaxis Number (%)
considered statistically significant. All statistical analyses SAPT (Aspirin) 87 (54.7)
were performed using MEDCALC statistical software
(MedCalc Software Ltd, Belgium). SAPT (Clopidogrel) 31 (19.6)
DAPT 36 (22.6)
3. Results DOAC 1 (0.6)
A total of 159 patients (75 females) with a median age AVK 3 (1.9)
of 73.5 (IQR = 66.75–79) years comprised the study None 1 (0.6)
population. SAF was detected in 82 (51.5%) patients. The Abbreviations: DAPT: Dual antiplatelet therapy; DOAC: Direct oral
main comorbidities included hypertension (75.4%), diabetes anticoagulants; VKA: Vitamin K antagonists; SAPT: Single-antiplatelet
(23.8%), and vascular diseases such as coronary artery therapy.
disease and/or peripheral artery disease (22.6%). Fifty-nine Table 2. Median time from stroke to a certain time point
(37.1%) patients were on antiplatelet therapy before stroke
onset. On hospital arrival, the median NIHSS score was Time frame Duration
2 (IQR = 1 – 5), and the median length of hospital stay was (median days [IQR])
7 (IQR = 6–9) days. At hospital discharge, the median mRS From stroke to ECG monitoring 115 (70 – 134)
was 1 (IQR = 0–3). Cortical and/or cortical/subcortical From stroke to ECG monitoring results 135 (92 – 155)
brain ischemic lesions were found in 117 (73.5%) patients, From stroke to OAC prescription 143 (94 – 178)
with 66 (41.5%) patients having ischemic lesions >2.5 cm in Abbreviations: ECG: Electrocardiogram; IQR: Interquartile range;
diameter. Multiple brain ischemic lesions were observed in OAC: Oral anticoagulant therapy.
81 (51%) patients, with 29 (18.2%) patients having bilateral
lesions, and 60 (37.7%) patients showing involvement of the Table 3. Prescription of secondary antithrombotic
posterior circle. Large vessel occlusion was present in 23.6% prophylaxis after the detection of atrial fibrillation in 2‑week
of patients, while hemorrhagic transformation occurred ECG monitoring
in 6.9%. Forty-three patients (27%) received systemic Secondary antithrombotic prophylaxis Patients (n [%])
thrombolysis and/or mechanical thrombectomy. The pre-
event median CHA DS -VASc score was 3 (IQR = 2 – 5), DOAC prescription 79 (96.2)
2
2
and the 90-day median mRS was 1 (IQR = 0–2). Table S1 Full dose 55 (67)
summarizes the characteristics of the study population. Full dose + Aspirin 100 mg 11 (13.5)
At hospital discharge, 154 (96.9%) patients received Full dose + Clopidogrel 1 (1.2)
antiplatelet therapy as secondary antithrombotic prophylaxis Low dose 9 (11)
(Table 1). Low dose + Aspirin 100 mg 2 (2.4)
Low dose + Clopidogrel 1 (1.2)
The median time from stroke onset to prolonged ECG
monitoring was 115 (IQR = 70 – 134) days, while the VKA prescription 2 (2.4)
median time from stroke onset to the result of prolonged VKA 1 (1.2)
ECG monitoring was 135 (IQR = 92 – 155) days (Table 2). VKA + Aspirin 100 mg 1 (1.2)
Among 77 patients in whom SAF was not detected by None OAC prescription 1 (1.2)
using non implantable ECG monitoring, five underwent Abbreviations: DOAC: Direct oral anticoagulants; OAC: Oral
implantable ECG monitoring. SAF was subsequently anticoagulant therapy; VKA: Vitamin K antagonists.

Volume 3 Issue 1 (2024) 3 https://doi.org/10.36922/an.2287