MDLinxAnticoagulants Fail to Prevent Unexplained Strokes, Clinical Trial Finds

Rethinking Stroke Prevention: The Unexpected Outcome of Anticoagulants in Atrial Cardiopathy

Recent findings from a collaborative clinical trial led by researchers at Columbia, Weill Cornell Medicine, and the University of Washington, published in JAMA, challenge the prevailing medical practice of prescribing anticoagulants for unexplained strokes in patients with atrial cardiopathy. This comprehensive study suggests a reassessment of treatment protocols, emphasizing the nuanced complexities of stroke prevention and the importance of definitive diagnosis in guiding therapy.

Key Points:

• The clinical trial involved 1,015 participants with atrial cardiopathy, a heart condition that resembles atrial fibrillation (AFib), a known cause of stroke. This trial sought to determine if anticoagulants could prevent secondary strokes in patients whose initial stroke cause was undetermined.
• Results revealed no significant difference in stroke rates between patients treated with the anticoagulant apixaban (4.4%) and those given aspirin, the current standard of care for such cases.
• Mitchell Elkind, MD, professor of neurology at the Vagelos College of Physicians and Surgeons and one of the study’s leaders, expressed disappointment but noted the importance of these findings for guiding treatment decisions for patients with atrial cardiopathy.
• The study highlights the complexity of stroke causes, with one-third of strokes remaining unexplained and presenting a challenge for effective prevention strategies.
• Elkind and his colleagues had hypothesized that anticoagulants would be beneficial for patients with atrial cardiopathy based on similarities to AFib, supported by previous epidemiological studies and analyses of stored blood samples from a 90s stroke prevention study.
• Despite the negative results, the research team urges not to abandon the concept of treating atrial cardiopathy but to refine patient selection criteria for anticoagulant therapy, suggesting further investigation into more specific biomarkers of atrial cardiopathy.
• The trial’s outcome suggests the need for a more precise definition of atrial cardiopathy and consideration of other contributing factors to unexplained strokes, such as atherosclerosis, smoking, or high blood pressure.

“It’s disappointing as a physician-scientist to not have your hypothesis proven, but this study is still providing really useful information,” Elkind says. “It tells neurologists that patients with this type of heart condition, atrial cardiopathy, should not get anticoagulants, which are riskier than aspirin and should be reserved for people with definitive evidence of atrial fibrillation.”
– Mitchell Elkind, MD, Professor of Neurology at the Vagelos College of Physicians and Surgeons

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