{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:31:39Z","timestamp":1760059899223,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicines"],"abstract":"<jats:p>Background\/Objectives: Atrial fibrillation (AF) is the most significant modifying risk factor for the development of cardioembolic stroke, which is associated with worse outcomes and higher intrahospital mortality compared to other types of ischemic stroke. Antithrombotic medications are administered as prophylactic treatment in patients with a risk of stroke. The aim of this study was to determine outcome measures in patients with first-ever ischemic stroke and AF regarding prior antithrombotic therapy. Methods: We collected data on stroke risk factors, CHADS2 score, and international normalized ratio (INR) value in the context of warfarin therapy, as well as data related to localization, stroke severity, and functional outcome at discharge. Results: A total of 754 subjects with first-ever ischemic stroke and AF were included in this cross-sectional study (122 on warfarin, 210 on acetylsalicylic acid, and 422 without prior antithrombotic therapy). The diagnosis of AF was previously unknown in 31% of the subjects. Stroke risk factors (arterial hypertension, hyperlipidemia, diabetes mellitus, and cardiomyopathy) were significantly lower in the group without prior antithrombotic therapy. The anticoagulant group was significantly younger (p = 0.001). Overall, 45.4% of subjects with a previously known AF event and a high risk of developing stroke received anticoagulant therapy. Participants on warfarin had a significantly better functional outcome than those on antiplatelet therapy or without prior antithrombotic therapy (median mRS 4 vs. 5 vs. 5; p = 0.025) and lower NIHSS scores, although the difference was not statistically significant (median 10 vs. 12 vs. 12; p = 0.09). There was no difference between stroke localization among groups (p = 0.116). Conclusions: Our study showed that, in our cohort, first-ever ischemic stroke due to AF was more common in women. Subjects on prior anticoagulant therapy had more favorable outcomes at discharge.<\/jats:p>","DOI":"10.3390\/medicines12030018","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T10:28:09Z","timestamp":1753352889000},"page":"18","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["First-Ever Stroke Outcomes in Patients with Atrial Fibrillation: A Retrospective Cross-Sectional Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Ivanka","family":"Maduna","sequence":"first","affiliation":[{"name":"Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia"},{"name":"Health Center of Osijek-Baranja County, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4569-1127","authenticated-orcid":false,"given":"Dorotea","family":"Vidakovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Memorial Hospital of Vukovar, 32000 Vukovar, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0901-5033","authenticated-orcid":false,"given":"Petra","family":"\u010crnac","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sveti Duh University Hospital, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5225-5414","authenticated-orcid":false,"given":"Christian","family":"Saleh","sequence":"additional","affiliation":[{"name":"University of Basel, 4001 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0184-8949","authenticated-orcid":false,"given":"Hrvoje","family":"Budin\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia"},{"name":"Department of Neurology, Sveti Duh University Hospital, 10000 Zagreb, Croatia"},{"name":"Department of Psychiatry and Neurology, Faculty of Dental Medicine and Health, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4037\/ccn2017127","article-title":"Cardioembolic Stroke: A Case Study","volume":"37","author":"Babkair","year":"2017","journal-title":"Crit. Care Nurse"},{"doi-asserted-by":"crossref","unstructured":"Tracz, J., Gorczyca-Glowacka, I., Rosolowska, A., and Wozakowska-Kaplon, B. (2023). Long-Term Outcomes after Stroke in Patients with Atrial Fibrillation: A Single Center Study. Int. J. Environ. Res. Public Health, 20.","key":"ref_2","DOI":"10.3390\/ijerph20043491"},{"unstructured":"(1994). Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet, 343, 687\u2013691.","key":"ref_3"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/S0140-6736(16)31257-0","article-title":"Stroke prevention in atrial fibrillation","volume":"388","author":"Freedman","year":"2016","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The euro heart survey on atrial fibrillation","volume":"137","author":"Lip","year":"2010","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e036458","DOI":"10.1161\/JAHA.124.036458","article-title":"Congenital Heart Disease, Atrial Fibrillation, and Ischemic Stroke Risk","volume":"13","author":"Fox","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1161\/STROKEAHA.116.013253","article-title":"Should Atrial Fibrillation Patients With Only 1 Nongender-Related CHA2DS2-VASc Risk Factor Be Anticoagulated?","volume":"47","author":"Fauchier","year":"2016","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"857","DOI":"10.7326\/0003-4819-146-12-200706190-00007","article-title":"Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation","volume":"146","author":"Hart","year":"2007","journal-title":"Ann. Intern. Med."},{"doi-asserted-by":"crossref","unstructured":"Franc, D., Sanak, D., Kral, M., Hutyra, M., Taborsky, M., Divisova, P., and Zapletalova, J. (2024). Impact of prior oral anticoagulation on admission stroke severity in patients with atrial fibrillation. Biomed. Pap.","key":"ref_10","DOI":"10.5507\/bp.2024.024"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1056\/NEJMoa022913","article-title":"Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation","volume":"349","author":"Hylek","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/S1474-4422(06)70536-1","article-title":"Preadmission antithrombotic treatment and stroke severity in patients with atrial fibrillation and acute ischaemic stroke: An observational study","volume":"5","author":"Oczkowski","year":"2006","journal-title":"Lancet Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1161\/CIRCULATIONAHA.121.056355","article-title":"Direct Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation: Patient-Level Network Meta-Analyses of Randomized Clinical Trials With Interaction Testing by Age and Sex","volume":"145","author":"Carnicelli","year":"2022","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s12959-024-00663-y","article-title":"Anticoagulation control for nonvalvular atrial fibrillation in a tertiary academic centre in Johannesburg","volume":"22","author":"Mogashoa","year":"2024","journal-title":"Thromb. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1002\/ana.27084","article-title":"Prevalence and Distribution of Intracranial Vessel Occlusion on Angiography and Its Association with Functional Outcome in Patients with Atrial Fibrillation Presenting with Ischemic Stroke","volume":"96","author":"Benz","year":"2024","journal-title":"Ann. Neurol."},{"doi-asserted-by":"crossref","unstructured":"Ujjin, A., Wongcharoen, W., Suwanagool, A., and Chai-Adisaksopha, C. (2024). Optimal Strategies to Select Warfarin Dose for Thai Patients with Atrial Fibrillation. J. Clin. Med., 13.","key":"ref_16","DOI":"10.3390\/jcm13092675"},{"doi-asserted-by":"crossref","unstructured":"Anduaga, I., Affronti, A., Cepas-Guillen, P., Alcocer, J., Flores-Umanzor, E., Regueiro, A., Brugaletta, S., Quintana, E., Sanchis, L., and Sabate, M. (2023). Non-Pharmacological Stroke Prevention in Atrial Fibrillation. J. Clin. Med., 12.","key":"ref_17","DOI":"10.3390\/jcm12175524"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/0140-6736(91)93206-O","article-title":"Classification and natural history of clinically identifiable subtypes of cerebral infarction","volume":"337","author":"Bamford","year":"1991","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1161\/STROKEAHA.117.017866","article-title":"Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials","volume":"48","author":"Broderick","year":"2017","journal-title":"Stroke"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1161\/01.STR.0000078562.82918.F6","article-title":"Sex differences in first-ever acute stroke","volume":"34","author":"Roquer","year":"2003","journal-title":"Stroke"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1159\/000052130","article-title":"Acute cerebrovascular disease in women","volume":"45","author":"Arboix","year":"2001","journal-title":"Eur. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.amjcard.2004.06.023","article-title":"Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study)","volume":"94","author":"Friberg","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2174\/1573403X15666181205110624","article-title":"Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes","volume":"15","author":"Westerman","year":"2019","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S1474-4422(15)70027-X","article-title":"Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: A systematic review and meta-analysis","volume":"14","author":"Sposato","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_25","first-page":"1","article-title":"Atrial fibrillation: An approach to diagnosis and management in the emergency department","volume":"23","author":"Milman","year":"2021","journal-title":"Emerg. Med. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e005657","DOI":"10.1161\/JAHA.117.005657","article-title":"Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients with Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation)","volume":"6","author":"Patti","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1161\/STROKEAHA.120.030138","article-title":"Initial Stroke Severity in Patients With Atrial Fibrillation According to Antithrombotic Therapy Before Ischemic Stroke","volume":"51","author":"Jung","year":"2020","journal-title":"Stroke"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1111\/ijs.12007","article-title":"Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation","volume":"10","author":"Tu","year":"2015","journal-title":"Int. J. Stroke"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1136\/jnnp.2004.048827","article-title":"Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke","volume":"76","author":"Kimura","year":"2005","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1161\/01.STR.0000157949.34986.30","article-title":"Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts","volume":"36","author":"Jackson","year":"2005","journal-title":"Stroke"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1159\/000068743","article-title":"Atrial fibrillation is associated with severe acute ischemic stroke","volume":"22","author":"Dulli","year":"2003","journal-title":"Neuroepidemiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"106564","DOI":"10.1016\/j.clineuro.2021.106564","article-title":"Risk factors among stroke subtypes and its impact on the clinical outcome of patients of Northern Portugal under previous aspirin therapy","volume":"203","author":"Medeiros","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1212\/WNL.43.1_Part_1.32","article-title":"Ischemic stroke in patients with atrial fibrillation: Effect of aspirin according to stroke mechanism. Stroke Prevention in Atrial Fibrillation Investigators","volume":"43","author":"Miller","year":"1993","journal-title":"Neurology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/j.jocn.2014.01.022","article-title":"Anticoagulation-related reduction of first-ever stroke severity in Chinese patients with atrial fibrillation","volume":"21","author":"Wang","year":"2014","journal-title":"J. Clin. Neurosci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1001\/jama.2017.1371","article-title":"Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation","volume":"317","author":"Xian","year":"2017","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/ane.13093","article-title":"Recurrent ischemic stroke: Incidence, predictors, and impact on mortality","volume":"140","author":"Khanevski","year":"2019","journal-title":"Acta Neurol. Scand."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1161\/STROKEAHA.115.008891","article-title":"Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study","volume":"46","author":"Paciaroni","year":"2015","journal-title":"Stroke"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/ijs.12473","article-title":"Antithrombotic treatment at onset of stroke with atrial fibrillation, functional outcome, and fatality: A systematic review and meta-analysis","volume":"10","author":"Hannon","year":"2015","journal-title":"Int. J. Stroke"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1002\/ana.24602","article-title":"Comparative Effectiveness of Prestroke Aspirin on Stroke Severity and Outcome","volume":"79","author":"Park","year":"2016","journal-title":"Ann. Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1161\/STROKEAHA.110.580225","article-title":"Differential effect of previous antiplatelet use on stroke severity according to stroke mechanism","volume":"41","author":"Kim","year":"2010","journal-title":"Stroke"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1159\/000083815","article-title":"Atrial fibrillation and the hypercoagulable state: From basic science to clinical practice","volume":"33","author":"Choudhury","year":"2003","journal-title":"Pathophysiol. Haemost. Thromb."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S1474-4422(22)00436-7","article-title":"Early rhythm-control therapy for atrial fibrillation in patients with a history of stroke: A subgroup analysis of the EAST-AFNET 4 trial","volume":"22","author":"Jensen","year":"2023","journal-title":"Lancet Neurol."},{"doi-asserted-by":"crossref","unstructured":"Kato, Y., Tsutsui, K., Nakano, S., Hayashi, T., and Suda, S. (2024). Cardioembolic Stroke: Past Advancements, Current Challenges, and Future Directions. Int. J. Mol. Sci., 25.","key":"ref_43","DOI":"10.3390\/ijms25115777"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e938","DOI":"10.1016\/S2352-3026(24)00281-3","article-title":"Changes in the landscape of anticoagulation: A focus on direct oral anticoagulants","volume":"11","author":"Ageno","year":"2024","journal-title":"Lancet Haematol."}],"container-title":["Medicines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6320\/12\/3\/18\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:15:12Z","timestamp":1760033712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6320\/12\/3\/18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,24]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medicines12030018"],"URL":"https:\/\/doi.org\/10.3390\/medicines12030018","relation":{},"ISSN":["2305-6320"],"issn-type":[{"type":"electronic","value":"2305-6320"}],"subject":[],"published":{"date-parts":[[2025,7,24]]}}}