Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study.

Details

Serval ID
serval:BIB_C345A68E92FA
Type
Article: article from journal or magazin.
Collection
Publications
Title
Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study.
Journal
Stroke
Author(s)
Paciaroni M., Agnelli G., Caso V., Tsivgoulis G., Furie K.L., Tadi P., Becattini C., Falocci N., Zedde M., Abdul-Rahim A.H., Lees K.R., Alberti A., Venti M., Acciarresi M., D'Amore C., Mosconi M.G., Cimini L.A., Procopio A., Bovi P., Carletti M., Rigatelli A., Cappellari M., Putaala J., Tomppo L., Tatlisumak T., Bandini F., Marcheselli S., Pezzini A., Poli L., Padovani A., Masotti L., Vannucchi V., Sohn S.I., Lorenzini G., Tassi R., Guideri F., Acampa M., Martini G., Ntaios G., Karagkiozi E., Athanasakis G., Makaritsis K., Vadikolias K., Liantinioti C., Chondrogianni M., Mumoli N., Consoli D., Galati F., Sacco S., Carolei A., Tiseo C., Corea F., Ageno W., Bellesini M., Colombo G., Silvestrelli G., Ciccone A., Scoditti U., Denti L., Mancuso M., Maccarrone M., Orlandi G., Giannini N., Gialdini G., Tassinari T., De Lodovici M.L., Bono G., Rueckert C., Baldi A., D'Anna S., Toni D., Letteri F., Giuntini M., Lotti E.M., Flomin Y., Pieroni A., Kargiotis O., Karapanayiotides T., Monaco S., Baronello M.M., Csiba L., Szabó L., Chiti A., Giorli E., Del Sette M., Imberti D., Zabzuni D., Doronin B., Volodina V., Michel P., Vanacker P., Barlinn K., Pallesen L.P., Kepplinger J., Bodechtel U., Gerber J., Deleu D., Melikyan G., Ibrahim F., Akhtar N., Gourbali V., Yaghi S.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
03/2017
Peer-reviewed
Oui
Volume
48
Number
3
Pages
726-732
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.
The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings.
The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events.
In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.

Keywords
Aged, Aged, 80 and over, Anticoagulants/adverse effects, Anticoagulants/therapeutic use, Atrial Fibrillation/complications, Atrial Fibrillation/therapy, Female, Hemorrhage/chemically induced, Humans, Ischemic Attack, Transient/complications, Ischemic Attack, Transient/drug therapy, Male, Prospective Studies, Recurrence, Risk Assessment/methods, Stroke/drug therapy, Thromboembolism/drug therapy, Warfarin/adverse effects, Warfarin/therapeutic use
Pubmed
Open Access
Yes
Create date
17/04/2017 18:43
Last modification date
20/08/2019 16:38
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