AccScience Publishing / AN / Online First / DOI: 10.36922/an.2287
SHORT COMMUNICATION

Subclinical atrial fibrillation in embolic stroke of undetermined source: Management and stroke recurrence

Luca Masotti1* Elisa Grifoni1 Alessia Baglini1 Teresa Sansone1 Mariella Baldini2 Sara Giannoni2 Elisabetta Bertini2 Ilaria Di Donato2 Irene Sivieri1 Marianna Mannini1 Gina Iandoli1 Ira Signorini1 Eleonora Cosentino1 Irene Micheletti1 Elisa Cioni1 Giulia Pelagalli1 Elisa Giglio1 Eleonora Brai1 Alessandro Dei1 Antonio Giordano1 Francesca Dainelli1 Mario Romagnoli1 Chiara Mattaliano1 Elena Schipani1 Giuseppe Salvatore Murgida1 Stefania Di Martino1 Valentina Francolini1
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1 Internal Medicine II and Stroke Unit, San Giuseppe Hospital, Empoli, Italy
2 Neurology, San Giuseppe Hospital, Empoli, Italy
Advanced Neurology 2024, 3(1), 2287 https://doi.org/10.36922/an.2287
Submitted: 21 November 2023 | Accepted: 19 January 2024 | Published: 20 March 2024
(This article belongs to the Special Issue Advances in stroke research and therapy)
© 2024 by the Author (s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Subclinical atrial fibrillation (SAF) represents the most prevalent underlying etiology detected after an embolic stroke of undetermined source (ESUS). Investigating SAF is strongly recommended during the diagnostic work-up. The efficacy of oral anticoagulant (OAC) therapy in reducing the risk of stroke recurrence post-SAF detection remains a conundrum. Thus, our study aimed to analyze the management of secondary antithrombotic prophylaxis and the rate of 12-month stroke recurrence in real-life ESUS patients. We retrospectively analyzed clinical, radiographic, and echocardiographic findings of patients with ESUS who underwent non-implantable 2-week electrocardiogram (ECG) monitoring after discharge. Episodes of SAF of any duration were considered diagnostic. Antithrombotic treatment at hospital discharge and after ECG monitoring, as well as 12-month recurrence, were registered. We compared the rate of stroke recurrence between patients with and without detection of SAF. One hundred and fifty-nine patients (75 females) with a median age of 73.5 (interquartile range [IQR] = 66.75 – 79) years represented the study population. At hospital discharge, 96.9% of patients received antiplatelet therapy as secondary antithrombotic prophylaxis. SAF was detected in 82 patients (51.5%), and OAC was prescribed in 98.6% of them. The median time from stroke onset to OAC prescription was 143 (IQR = 94 – 178) days. Overall, 12-month stroke recurrence occurred in eight patients (5%). The stroke recurrence rate was lower in patients prescribed OAC compared with those not prescribed it, although the difference was not significant (3.7% vs. 6.25%; P = 0.7202). In our study, OACs prescribed post-SAF detection in patients with ESUS reduced, but not significantly, the risk of stroke recurrence. Future research and prospective multicenter studies are warranted.

Keywords
Atrial fibrillation
Stroke
Embolic stroke of undetermined source
Score
Electrocardiogram monitoring
Oral anticoagulants
Recurrence
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing