Functional Outcome and Mortality of Cardioembolic Stroke Patients Dependent on Antithrombotic Therapy. Doctoral Thesis
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Date
2025
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Rīga Stradiņš University
Abstract
Stroke, classified by the World Health Organisation (WHO) as a cardiovascular disease, remains a leading cause of mortality and morbidity, while ischaemic stroke (IS) is the second most common cause of death and a significant contributor to disability-adjusted life years (DALYs) lost worldwide. Latvia has an exceptionally high IS incidence and mortality rate compared to other European countries, mainly due to cardioembolic stroke (CS), a severe IS subtype often linked to non-valvular atrial fibrillation (NVAF). Despite advances in treatment, the prevalence of CS is expected to rise, posing a considerable burden on the ageing population. Effective management of NVAF with oral anticoagulants (OACs), particularly target-specific oral anticoagulants (TSOACs), could potentially reduce CS incidence and improve long-term outcomes, yet their use remains suboptimal. This Thesis aims to evaluate the impact of antithrombotic therapy on mortality and long-term functional outcomes in CS patients within the Latvian population. The Thesis is structured in three parts to address various aspects of CS prevention and patient care. The first aspect focuses on primary CS prevention strategies. The second aspect delves into the characteristics and demographics of CS patients during hospitalisation. And the third aspect examines secondary prevention strategies and long-term functional outcomes for these patients. Findings indicate that CS is the most prevalent and severe IS subtype in Latvia. CS patients are typically older, predominantly female, and have higher rates of comorbid conditions. Despite higher reperfusion therapy rates, CS leads to longer hospitalizations, poorer outcomes, and higher in-hospital and long-term mortality. There is significant underuse of antithrombotic medications in NVAF patients, often due to age and stroke severity biases. OACs improve functional outcomes and survival in CS patients, with TSOACs preferred over vitamin K antagonists (VKAs) due to a better safety profile. Proper use of TSOACs is linked to lower long-term mortality and improved functional independence, underscoring their importance in secondary stroke prevention.
Description
The Doctoral Thesis was developed at Rīga Stradiņš University and the Pauls Stradiņš Clinical University Hospital, Riga, Latvia. Defence of the Doctoral Thesis will take place at the public session of the Promotion Council of Clinical Medicine on 30 April 2025 at 15.00 in the Hippocrates Lecture Theatre, 16 Dzirciema Street, Rīgas Stradiņš University and remotely via online platform Zoom.
Keywords
Doctoral Thesis, cardioembolic stroke, stroke prevention, atrial fibrillation, stroke mortality, stroke functional outcome
Citation
Jurjāns, K. 2025. Functional Outcome and Mortality of Cardioembolic Stroke Patients Dependent on Antithrombotic Therapy: Doctoral Thesis: Sub-Sector – neurology. Rīga: Rīga Stradiņš University. https://doi.org/10.25143/prom-rsu_2025-08_dt