The following is a summary of “Clinical and Biomarker Determinants for Recurrent Stroke in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis, Controlled Trial,” published in the December 2024 issue of Neurology by Cheung et al.  

Despite effective secondary prevention, including oral anticoagulants (OAC), people with atrial fibrillation (AF) continue to face a substantial risk of recurrent stroke (RS), with an annualized risk of 3.2% to 6.5%.  

Researchers conducted a retrospective study to investigate the clinical factors and biomarkers associated with RS in people who have had an AF-related stroke.  

They searched Embase/Ovid Medline (August 2023) and included studies regardless of OAC use. Risk ratios (RRs) were pooled using random effects models.  

The results showed that clinical factors associated with RS included the CHA2DS2-VASc score (RR 1.22, 95% CI 1.15-1.30, per point), stroke despite OAC (RR 1.55, 95% CI 1.23-1.94), sustained AF (RR 1.44, 95% CI 1.19-1.75), hyperlipidemia (RR 1.27, 95% CI 1.05-1.53), chronic kidney disease (RR 1.86, 95% CI 1.19-2.92), and malignancy (RR 4.36, 95% CI 1.85-10.78). National Institutes of Health Stroke Scale (NIHSS) scores (RR 0.97, 95% CI 0.95-0.99) and Asian ethnicity (RR 0.59, 95% CI 0.36-0.97) were linked to a reduced risk of recurrence. Neuroimaging markers associated with RS included chronic lacunar (RR 1.91, 95% CI 1.29-2.84) and embolic-appearing infarcts (RR 2.76, 95% CI 1.32-5.77), along with cerebral microbleeds (RR 1.29, 95% CI 1.04-1.59). Echocardiographic markers included atrial size (RR 1.40, 95% CI 1.12-1.75 per cm/m²), intracardiac thrombus (RR 1.99, 95% CI 1.38-2.87), spontaneous left atrial appendage (LAA) contrast (RR 2.91, 95% CI 1.21-6.17), and low LAA intensity variation (RR 2.81, 95% CI 1.48-5.32), data on blood biomarkers was limited.  

They concluded that several clinical factors, including AF burden and stroke despite OAC use, as well as biomarkers of atrial cardiopathy, small vessel disease, or previous infarction, are associated with RS in people with AF.  

Source: neurology.org/doi/10.1212/WNL.0000000000210061