{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:43:39Z","timestamp":1792226619257,"version":"4.4.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose\u2014<\/jats:title>\n                    <jats:p>Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non\u2013vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\u2014<\/jats:title>\n                    <jats:p>Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results\u2014<\/jats:title>\n                    <jats:p>\n                      Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95\u20135.85), atrial enlargement (OR, 6.64; 95% CI, 4.63\u20139.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83\u20133.16), and CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score (OR, 1.72 for each point increase; 95% CI, 1.58\u20131.88) were associated with ischemic events. Among the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33\u20130.61).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>\n                      In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score were associated with increased risk of cerebrovascular events.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.119.025350","type":"journal-article","created":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T08:03:17Z","timestamp":1561449797000},"page":"2168-2174","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":89,"title":["Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non\u2013Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention"],"prefix":"10.1161","volume":"50","author":[{"given":"Maurizio","family":"Paciaroni","sequence":"first","affiliation":[{"name":"From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Agnelli","sequence":"additional","affiliation":[{"name":"From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Caso","sequence":"additional","affiliation":[{"name":"From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Silvestrelli","sequence":"additional","affiliation":[{"name":"S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Italy (G.S., A.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Julian","family":"Seiffge","sequence":"additional","affiliation":[{"name":"University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Engelter","sequence":"additional","affiliation":[{"name":"University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"De Marchis","sequence":"additional","affiliation":[{"name":"University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Polymeris","sequence":"additional","affiliation":[{"name":"University Center for Medicine of Aging and Rehabilitation, University of Basel, Felix-Platter Hospital, Switzerland (D.J.S., S.E., G.M.D.M., A. Polymeris)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Zedde","sequence":"additional","affiliation":[{"name":"Neurology Unit, Stroke Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy (M.L.Z.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadi","family":"Yaghi","sequence":"additional","affiliation":[{"name":"New York University Langone Health (S.Y.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Michel","sequence":"additional","affiliation":[{"name":"D\u00e9partement des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Centre C\u00e9r\u00e9brovasculaire, Service de Neurologie, Lausanne, Switzerland (P.M., A.E.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Eskandari","sequence":"additional","affiliation":[{"name":"D\u00e9partement des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Centre C\u00e9r\u00e9brovasculaire, Service de Neurologie, Lausanne, Switzerland (P.M., A.E.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kateryna","family":"Antonenko","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine (K.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Il","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (S.I.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Cappellari","sequence":"additional","affiliation":[{"name":"Struttura Semplice Ospedaliera Stroke Unit, Unit\u00e0 Organica Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., B.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Tassinari","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy (T.T., V.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Tassi","sequence":"additional","affiliation":[{"name":"Stroke Unit, AOU Senese, Siena, Italy (R.T., F.G., M.A., G.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Masotti","sequence":"additional","affiliation":[{"name":"Internal Medicine, San Giuseppe Hospital, Empoli, Italy (L.M., E. Grifoni)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristeidis H.","family":"Katsanos","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Ioannina, Greece (A.H.K., S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotirios","family":"Giannopoulos","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Ioannina, Greece (A.H.K., S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Acciarresi","sequence":"additional","affiliation":[{"name":"From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. 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Paciaroni, G.A., V.C., M.A., A.A., M.V., M.G.M., M.C.V., P.P., M.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico Maria","family":"Lotti","sequence":"additional","affiliation":[{"name":"U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy (E.M.L., M. Padroni)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Ntaios","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Thessaly, Larissa, Greece (G.N., E.K., K.P., K.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odysseas","family":"Kargiotis","sequence":"additional","affiliation":[{"name":"Stroke Unit, Metropolitan Hospital, Piraeus, Greece (O.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Monaco","sequence":"additional","affiliation":[{"name":"Stroke Unit, Ospedale Civico, Palermo, Italy (S.M., M. 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