TY  - JOUR
A1  - Wutzler, Alexander
A1  - Krogias, Christos
A1  - Grau, Anna
A1  - Veltkamp, Roland
A1  - Heuschmann, Peter U.
A1  - Haeusler, Karl Georg
T1  - Stroke prevention in patients with acute ischemic stroke and atrial fibrillation in Germany - a cross sectional survey
JF  - BMC Neurology
N2  - Background
Atrial fibrillation (AF) is present in 15–20% of patients with acute ischemic stroke. Oral anticoagulation reduces the risk of AF-related recurrent stroke but clinical guideline recommendations are rather vague regarding its use in the acute phase of stroke. We aimed to assess the current clinical practice of medical stroke prevention in AF patients during the acute phase of ischemic stroke.

Methods
In April 2017, a standardized anonymous questionnaire was sent to clinical leads of all 298 certified stroke units in Germany.

Results
Overall, 154 stroke unit leads participated (response rate 52%). Anticoagulation in the acute phase of stroke is considered feasible in more than 90% of AF patients with ischemic stroke. Clinicians assume that about two thirds of all AF patients (range 20–100%) are discharged on oral anticoagulation. According to local preferences, acetylsalicylic acid is given orally in the majority of patients with delayed initiation of oral anticoagulation. A non-vitamin K-dependent oral anticoagulant (NOAC) is more often prescribed than a vitamin K-dependent oral anticoagulant (VKA). VKA is more often chosen in patients with previous VKA intake than in VKA naive patients. In the minority of patients, stroke unit leads discuss the prescription of a specific oral anticoagulant with the treating general practitioner. Adherence to medical stroke prevention after hospital discharge is not assessed on a regular basis in any patient by the majority of participating stroke centers.

Conclusions
Early secondary stroke prevention in AF patients in German stroke units is based on OAC use but prescription modalities vary in clinical practice.
KW  - Ischemic stroke
KW  - Secondary stroke prevention
KW  - Atrial fibrillation
KW  - Survey
KW  - Oral anticoagulation
KW  - Stroke unit
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201078
VL  - 19
ER  - 
TY  - JOUR
A1  - Tütüncü, Serdar
A1  - Olma, Manuel C.
A1  - Kunze, Claudia
A1  - Krämer, Michael
A1  - Dietzel, Joanna
A1  - Schurig, Johannes
A1  - Filser, Paula
A1  - Pfeilschifter, Waltraud
A1  - Hamann, Gerhard F.
A1  - Büttner, Thomas
A1  - Heuschmann, Peter U.
A1  - Kirchhof, Paulus
A1  - Laufs, Ulrich
A1  - Nabavi, Darius G.
A1  - Röther, Joachim
A1  - Thomalla, Götz
A1  - Veltkamp, Roland
A1  - Eckardt, Kai‐Uwe
A1  - Haeusler, Karl Georg
A1  - Endres, Matthias
T1  - Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack
JF  - European Journal of Neurology
N2  - Background and purpose
Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
Methods
The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD‐EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m\(^{2}\). eGFR dynamics were classified based on two in‐hospital values as “stable normal” (≥60 ml/min/1.73 m\(^{2}\)), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m\(^{2}\)), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m\(^{2}\)), and “stable decreased” (<60 ml/min/1.73 m\(^{2}\)). The composite endpoint (stroke, major bleeding, myocardial infarction, all‐cause death) was assessed after 24 months. We estimated hazard ratios in confounder‐adjusted models.
Results
Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m\(^{2}\) at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40–3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07–2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20–2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95% CI = 1.51–6.10) and decreasing eGFR were associated with all‐cause death (HR = 3.12, 95% CI = 1.63–5.98).
Conclusions
In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.
KW  - kidney function
KW  - prognosis
KW  - stroke
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-287271
VL  - 29
IS  - 9
SP  - 2716
EP  - 2724
ER  -