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There is a known link between low left ventricular ejection fraction (LVEF) and ischemic stroke risk
.
Despite the increased risk of ischemic stroke in patients with low LVEF and sinus rhythm, uncertainty remains about the optimal antithrombotic drug therapy strategy for ischemic stroke prevention
Uncertainty remains about the optimal antithrombotic drug therapy strategy for ischemic stroke prevention
In 2002, the WARIS II trial demonstrated the superiority of warfarin over aspirin after myocardial infarction in preventing composite outcomes including thromboembolic ischemic stroke
.
2004-2014, WASH (warfarin/aspirin heart failure study), HELAS (heart failure long-term antithrombotic study), WATCH (warfarin and antiplatelet therapy in chronic heart failure) and WARCEF (warfarin and aspirin therapy Anticoagulated patients with low LVEF and sinus rhythm had a reduced risk of ischemic stroke (odds ratio, 0.
Anticoagulated patients with low LVEF and sinus rhythm had a reduced risk of ischemic stroke
The clinical balance of anticoagulation in these patients is reflected in the 2014 guidelines, which recommend anticoagulation for patients with LVEF ≤ 35% as class IIb and grade of evidence as
B.
From this, Anna D.
Baker et al.
of Yale University describe disease burden and variability in practice:
(1) Estimate the prevalence of LVEF ≤40% and sinus rhythm in patients with acute ischemic stroke (AIS)
(2) To describe the antithrombotic prescription pattern of AIS patients with LVEF≤40%, no history of atrial fibrillation (AF), and no other anticoagulation indications from 2002 to 2018 in the clinical equivalence era of AIS patients
.
This is a multicenter, retrospective cohort study of patients with AIS hospitalized in the Greater Cincinnati Area Northern Kentucky Stroke Study and 4 academic hospital cohorts in the United States
.
A 1-stage proportional meta-analysis was performed to calculate pooled prevalence
Among 14,338 AIS patients with documented LVEF during stroke hospitalization, the weighted pooled prevalence of LVEF ≤40% and sinus rhythm was 5.
0% (95% CI, 4.
1-6.
0%; I2, 84.
4%)
.
Of the 524 patients who survived discharge without myocardial thrombosis and who were not indicated for anticoagulants, 200 (38%) were discharged on anticoagulant, 289 (55%) were discharged on antiplatelet therapy alone, and 35 were discharged on antiplatelet therapy.
There was regional heterogeneity in the proportion of anticoagulants used at discharge (22% to 45%, P<0.
0001)
.
In adjusted analyses, cohort location and National Institutes of Health Stroke Severity Scale >8 (OR, 2.
There was regional heterogeneity in the proportion of anticoagulants used at discharge (22% to 45%, P<0.
Significant differences in site and stroke severity in clinical practice of antithrombotic therapy prescriptions
Original source:
Baker AD, Schwamm LH, Sanborn DY, et al.
Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns.
Stroke.
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