Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography

Mohamed Ahmed Zaki; Hamouda Abdel Khalek El-Bahnasy

doi:doi:10.11648/j.cnn.20230701.13

| Peer-Reviewed

Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography

Mohamed Ahmed Zaki, Hamouda Abdel Khalek El-Bahnasy

Published in Clinical Neurology and Neuroscience (Volume 7, Issue 1)

Received: 17 February 2023 Accepted: 8 March 2023 Published: 20 March 2023

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Warfarin with optimized international normalization ratio (INR); is significantly affect the Micro embolic signals (MES), in many studies. Non vitamin k antagonist oral anticoagulants (NOACs) are recently approved for stroke prevention in non valvular AF. In contrast to Warfarin; effect of NOACs on MES is not yet fully researched. Aim: To determine the effect of NOACs on MES, in comparison to warfarin in non valvular AF, to reflect the potential embolization risk. Methods: The incidence and number of MES was studied in patients with non valvular AF. Two groups in the current study; the first, patients were put on warfarin with INR levels were optimized to (2-3), and considered as a control group. The second; patients were put on NOAC (rivaroxaban, 15 mg /day). Study patients were recruited from cardiology outpatient clinics and departments (Al-Azhar University hospitals; Cairo and New Damietta, Egypt). Patients of the both groups were subjected to MES detection and counting by transcranial Doppler ultrasonography (TCD) monitoring. Results: MES did not detected in 22.5% in study groups; no statistically significant differences between study groups. The incidence and number of MES; within the warfarin group; MES were detected in (30 patients, 75%), while within the rivaroxaban group (32 patients, 80%). The average number of MES; in group one were (11.65 ±7.20), and in group two (11.50 ±7.20), with no significant statistical difference also. Conclusion: The effect of warfarin and NOAC use is not statistically different and Rivaroxaban is not inferior to warfarin.

Published in	Clinical Neurology and Neuroscience (Volume 7, Issue 1)
DOI	10.11648/j.cnn.20230701.13
Page(s)	13-17
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Anticoagulation, NOACs, Cerebral Microembli, Nonvalvular Atrial Fibrillation, Transcranial Doppler Ultrasonography

References

[1]	Abdullah M. Alshehri. Stroke in atrial fibrillation: Review of risk stratification and preventive therapy: J Family Community Med 2019; 26 (2): 92-97.
[2]	Flint AC, Banki NM, Ren X, Rao VA, and Go AS. Detection of paroxysmal atrial fibrillation by 30 day event monitoring in cryptogenic ischemic stroke. Stroke 2012; 43: 2788-90.
[3]	Odutay A, Wong C, Hasiao A, Hopwell S, Altman D, Emidn C. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: BMJ 2016; 354: 14482.
[4]	Lane D, Skjoth F, Lip GY, Larsen T, Kotecho D. Temporal trends in incidence, prevalence, and mortality of atrial fibrillation in primary care: J Am Heart Assoc 2017; 6ie005155.
[5]	Dhungana S and Ghimire R. Prevalence of valvular and non valvular atrial fibrillation and the application of antithrombotic treatment in a tertiary care hospital: JNMA J Nepal Med Assoc 2020; 58: 851-855.
[6]	Steffel J, Collins R, Antz M, Cornu P, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non- Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace 2021; 23, 1612- 1676.
[7]	Chern- En C, Tze- Fan C, Eue- Keun C, et al. Stroke Prevention in Atrial Fibrillation. JACC: Asia 2022; 2, 395- 411.
[8]	Oldgren J, Asberg S, Hijazi Z, Wester P, et al. Early Versus Delayed Non- Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry- Based Randomized Controlled Noninferiority Study. Circulation 2022; 146: 1056 - 1066.
[9]	Patel M, Mahaffey K, Garg J, Pan G, Singer D, et al. Rivaroxaban versus warfarin in non valvular atrial fibrillation: N Engl J Med. 2011; 365: 383-91.
[10]	Hicks T, Stewart F, and Eisinga A. NOACs versus warfarin for stroke prevention in patients with AF: a systemic review and meta-analysis. BMJ 2016; volume 3, issue 1.
[11]	El-Bahnasy H and Zaki M. incidence of the cerebral microembolization in patients with nonvalvular atrial fibrillation using transcranial Doppler: Al-Azhar Assiut Med J 2022, 20: 211-217.
[12]	Vukovic-Cvetkovic V. Microembolus detection by transcranial Doppler sonography: review of the literature. Stroke Res Treat 2012: 361-382.
[13]	Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.
[14]	Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.
[15]	Vuković- Ċvetković V. Microembolus detection by transcranial Doppler sonography: review of the literature. Stroke Res Treat 2012; 382361.
[16]	Engel A, Horvat Menih I, Hueepfl M, Erdoes G, et al. Detection and differentiaon cerebral microemboli in patients undergoing major orthopedic surgery using transcranial Doppler ultrasound. Br J Anaesth 2017; 118: 400-406.
[17]	Wu J, Zhang Y, Liao X, Lei Y. Anticoagulation therapy for nonvalvular atrial fibrillation: a mini review. Front Med (Lausanne) 2020; 7: 350.
[18]	Murphy A, Lim ST, Kinsella JA, Tierney S, Egan B, Feeley TM, et al. Simaltaneous assessment of plaque morphology, cerebral microembolic signal status and platelet biomarker in patients with recently symptomatic and a symptomatic carotid stenosis. J Cereb Blood Flow Metab 2020; 40: 2201-2214.
[19]	Anzola GP, et al. Transcranial Doppler monitoring of cerebral embolism in atrial fibrillation and prosthetic valve: clinical correlation. Eur J Neurol 1995.
[20]	Von Bary C, Deneke, et al. Online measurement of microembolic signal burden by transcranial Doppler during catheter ablation of atrial – results of a multicenter trial: Front Neurol 2017; volume 8.
[21]	Bazan R, Jose G, et al. Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity and mortality of ischemic stroke: a prospective study: The Ultrasound Journal 2020.
[22]	Larbig R, Dittrich R, Koehhaeuser S, Leitz P, and et al. Influence of Clinical Parameters and Coagulation on Intraprocedural Cerebral Microemboli Signals during Pulmonary vein Isolation. J PloS One 2016; 11 (6): 0157886.
[23]	Eikelboom J, Connolly S, et al. Dabigatran versus warfarin in patients with mechanical heart valves. Engl J Med 2013; 369: 1206-1214.
[24]	Demir S, Ozda MF and Togrol R. What do anticoagulant say about microemboli: J Stroke Cerebrovasc Dis 2015; 24: 2474-2477.
[25]	Xueping Z, Weizhen W, Linc, David E, et al. Apixaban Inhibits Cerebral Microembolic signals Derived from Carotid Arterial Thrombosis in Rabbits. Journal of Pharmacology and Expermintal Theraputics 2016; 358 (3): 405-412.
[26]	Wieczorek M, Bogossian H, Bandorski D, and Hoeltgen R. Uninterrupted use of direct oral anticoagulants versus vitamin K antagonists for catheter ablation of atrial fibrillation with PVAC goldi incidence of silent cerebral microembolic event. Journal of International Cardiac Electrophysiology 2021; Vol. 62 Issue 1, 39-47.
[27]	Shpak M, Nadasdy Z, and Fanalec. Higher Incidence of Ischemic Stroke in Patients Taking Novel Oral Anticoagulants. Stroke 2018; 49: 2851-2856.
[28]	Aristeidis HK, Hooman K, Jeff S, and Robert G. Stroke Prevention in Atrial Fibrillation. Circulation 2020; 142: 2371-2388.
[29]	Serkan D, Mehmet F. Ozdag, Mustafa T. Kendirli, and Rifat E. Togrol. What Do Anticoagulants Say about Microemboli?. J Stroke Cerebrovasc Dis. 2015; volume 24, issue 11, 2474-2477.

Cite This Article

Plain Text BibTeX RIS

APA Style

Mohamed Ahmed Zaki, Hamouda Abdel Khalek El-Bahnasy. (2023). Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography. Clinical Neurology and Neuroscience, 7(1), 13-17. https://doi.org/10.11648/j.cnn.20230701.13

Copy | Download

ACS Style

Mohamed Ahmed Zaki; Hamouda Abdel Khalek El-Bahnasy. Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography. Clin. Neurol. Neurosci. 2023, 7(1), 13-17. doi: 10.11648/j.cnn.20230701.13

Copy | Download

AMA Style

Mohamed Ahmed Zaki, Hamouda Abdel Khalek El-Bahnasy. Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography. Clin Neurol Neurosci. 2023;7(1):13-17. doi: 10.11648/j.cnn.20230701.13

Copy | Download

@article{10.11648/j.cnn.20230701.13,
  author = {Mohamed Ahmed Zaki and Hamouda Abdel Khalek El-Bahnasy},
  title = {Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography},
  journal = {Clinical Neurology and Neuroscience},
  volume = {7},
  number = {1},
  pages = {13-17},
  doi = {10.11648/j.cnn.20230701.13},
  url = {https://doi.org/10.11648/j.cnn.20230701.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20230701.13},
  abstract = {Background: Warfarin with optimized international normalization ratio (INR); is significantly affect the Micro embolic signals (MES), in many studies. Non vitamin k antagonist oral anticoagulants (NOACs) are recently approved for stroke prevention in non valvular AF. In contrast to Warfarin; effect of NOACs on MES is not yet fully researched. Aim: To determine the effect of NOACs on MES, in comparison to warfarin in non valvular AF, to reflect the potential embolization risk. Methods: The incidence and number of MES was studied in patients with non valvular AF. Two groups in the current study; the first, patients were put on warfarin with INR levels were optimized to (2-3), and considered as a control group. The second; patients were put on NOAC (rivaroxaban, 15 mg /day). Study patients were recruited from cardiology outpatient clinics and departments (Al-Azhar University hospitals; Cairo and New Damietta, Egypt). Patients of the both groups were subjected to MES detection and counting by transcranial Doppler ultrasonography (TCD) monitoring. Results: MES did not detected in 22.5% in study groups; no statistically significant differences between study groups. The incidence and number of MES; within the warfarin group; MES were detected in (30 patients, 75%), while within the rivaroxaban group (32 patients, 80%). The average number of MES; in group one were (11.65 ±7.20), and in group two (11.50 ±7.20), with no significant statistical difference also. Conclusion: The effect of warfarin and NOAC use is not statistically different and Rivaroxaban is not inferior to warfarin.},
 year = {2023}
}

Copy | Download

TY - JOUR
T1 - Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography
AU - Mohamed Ahmed Zaki
AU - Hamouda Abdel Khalek El-Bahnasy
Y1 - 2023/03/20
PY - 2023
N1 - https://doi.org/10.11648/j.cnn.20230701.13
DO - 10.11648/j.cnn.20230701.13
T2 - Clinical Neurology and Neuroscience
JF - Clinical Neurology and Neuroscience
JO - Clinical Neurology and Neuroscience
SP - 13
EP - 17
PB - Science Publishing Group
SN - 2578-8930
UR - https://doi.org/10.11648/j.cnn.20230701.13
AB - Background: Warfarin with optimized international normalization ratio (INR); is significantly affect the Micro embolic signals (MES), in many studies. Non vitamin k antagonist oral anticoagulants (NOACs) are recently approved for stroke prevention in non valvular AF. In contrast to Warfarin; effect of NOACs on MES is not yet fully researched. Aim: To determine the effect of NOACs on MES, in comparison to warfarin in non valvular AF, to reflect the potential embolization risk. Methods: The incidence and number of MES was studied in patients with non valvular AF. Two groups in the current study; the first, patients were put on warfarin with INR levels were optimized to (2-3), and considered as a control group. The second; patients were put on NOAC (rivaroxaban, 15 mg /day). Study patients were recruited from cardiology outpatient clinics and departments (Al-Azhar University hospitals; Cairo and New Damietta, Egypt). Patients of the both groups were subjected to MES detection and counting by transcranial Doppler ultrasonography (TCD) monitoring. Results: MES did not detected in 22.5% in study groups; no statistically significant differences between study groups. The incidence and number of MES; within the warfarin group; MES were detected in (30 patients, 75%), while within the rivaroxaban group (32 patients, 80%). The average number of MES; in group one were (11.65 ±7.20), and in group two (11.50 ±7.20), with no significant statistical difference also. Conclusion: The effect of warfarin and NOAC use is not statistically different and Rivaroxaban is not inferior to warfarin.
VL - 7
IS - 1
ER -

Copy | Download

Author Information

Mohamed Ahmed Zaki

Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Hamouda Abdel Khalek El-Bahnasy

Departement of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Mohamed Ahmed Zaki, Hamouda Abdel Khalek El-Bahnasy. (2023). Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography. Clinical Neurology and Neuroscience, 7(1), 13-17. https://doi.org/10.11648/j.cnn.20230701.13

Copy | Download

ACS Style

Mohamed Ahmed Zaki; Hamouda Abdel Khalek El-Bahnasy. Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography. Clin. Neurol. Neurosci. 2023, 7(1), 13-17. doi: 10.11648/j.cnn.20230701.13

Copy | Download

AMA Style

Mohamed Ahmed Zaki, Hamouda Abdel Khalek El-Bahnasy. Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography. Clin Neurol Neurosci. 2023;7(1):13-17. doi: 10.11648/j.cnn.20230701.13

Copy | Download

@article{10.11648/j.cnn.20230701.13,
  author = {Mohamed Ahmed Zaki and Hamouda Abdel Khalek El-Bahnasy},
  title = {Non Vitamin k Antagonist Oral Anticoagulation Assessment in Non Valvular Atrial Fibrillation Using Transcranial Doppler Ultrasonography},
  journal = {Clinical Neurology and Neuroscience},
  volume = {7},
  number = {1},
  pages = {13-17},
  doi = {10.11648/j.cnn.20230701.13},
  url = {https://doi.org/10.11648/j.cnn.20230701.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20230701.13},
  abstract = {Background: Warfarin with optimized international normalization ratio (INR); is significantly affect the Micro embolic signals (MES), in many studies. Non vitamin k antagonist oral anticoagulants (NOACs) are recently approved for stroke prevention in non valvular AF. In contrast to Warfarin; effect of NOACs on MES is not yet fully researched. Aim: To determine the effect of NOACs on MES, in comparison to warfarin in non valvular AF, to reflect the potential embolization risk. Methods: The incidence and number of MES was studied in patients with non valvular AF. Two groups in the current study; the first, patients were put on warfarin with INR levels were optimized to (2-3), and considered as a control group. The second; patients were put on NOAC (rivaroxaban, 15 mg /day). Study patients were recruited from cardiology outpatient clinics and departments (Al-Azhar University hospitals; Cairo and New Damietta, Egypt). Patients of the both groups were subjected to MES detection and counting by transcranial Doppler ultrasonography (TCD) monitoring. Results: MES did not detected in 22.5% in study groups; no statistically significant differences between study groups. The incidence and number of MES; within the warfarin group; MES were detected in (30 patients, 75%), while within the rivaroxaban group (32 patients, 80%). The average number of MES; in group one were (11.65 ±7.20), and in group two (11.50 ±7.20), with no significant statistical difference also. Conclusion: The effect of warfarin and NOAC use is not statistically different and Rivaroxaban is not inferior to warfarin.},
 year = {2023}
}

Copy | Download