Main aims of the project

Atrial fibrillation (AF) causes cardioembolism and ischemic stroke. Long-term oral anticoagulation is the mainstay therapy for ischemic stroke prevention, but benefits have to be balanced against the risk of bleeding, mainly of intracranial hemorrhage (ICH). Moreover, anticoagulation does not completely eliminate the risk of ischemic stroke and thromboembolism in AF patients. On one side we need to identify those patients at highest risk of ICH, for whom it would be better to avoid anticoagulants, while on the other side we need to identify patients at highest risk of thromboembolisms despite anticoagulation, for whom add-on treatments might be advocated. Available stroke and bleeding risk stratification schemes rely on just clinical information, validity of which remains controversial and needs to be improved.
Attempts have been made to refine the scores by the addition of biomarkers (blood, urine, cardiac and cerebral imaging), but data are still inconclusive as to whether the costs are justified. Neuroimaging markers, especially those related to cerebral small vessel disease, may act as surrogate marker of the bleeding and ischemic risk. Biomarkers of atrial dysfunction or cardiopathy are associated with ischemic stroke risk, and particularly those related to embolism. Metabolomics allows the identification, quantification and characterization of the complete set of low molecular weight metabolites (the metabolome), and has the potential to discover new systemic markers of embolic/hemorrhagic risk profile in AF patients.

By means of Strat-AF-2 study we aim to evaluate in AF patients under treatment with any type of oral anticoagulants:

1. The potential incremental value of a wide set of biological markers (clinical, circulating, metabolomics and neuroimaging) and of their possible interaction, on the prediction of bleeding risk.

2. The potential value of biological markers (clinical, circulating, metabolomics, cerebral and cardiac imaging) and of their possible interaction, on the prediction of thromboembolic risk.

The Strat-AF-2 study is the second phase of the Strat-AF (www.strat-af.it) single center, longitudinal observational study that enrolled elderly patients with AF on oral anticoagulation for primary or secondary prevention of stroke (Ministry of Health and Tuscany Region, Bando Ricerca Finalizzata 2013).

Coordinating group

Anna Poggesi and Emilia Salvadori
Rossella Marcucci
Antonio Di Carlo

Neuro Group

Anna Poggesi
Francesca Pescini
Cristina Sarti
Francesco Arba
Mariella Lamassa
Carmen Barbato
Benedetta Formelli

Lab Group

Rossella Marcucci
Cesari Francesca
Betti Giusti
Anna Maria Gori
Leonardo Tenori
Alessia Vignoli

Radio Group

Enrico Fainardi
Manlio Acquafresca
Silvia Pradella
Ivano Lombardo
Giorgio Busto
Stefano Chiti

Cardio Group

Francesco Meucci
Giulia Pontecorboli
Martina Berteotti

Stat Group

Antonio Di Carlo
Maria Elena Della Santa
Marzia Baldereschi
Giovanni Pracucci
Emilia Salvadori

Principal Investigator: Prof.ssa Anna Poggesi, MD, PhD
NEUROFARBA Department, University of Florence, Italy

The Strat-AF-2 study was funded by Tuscany region within the call Bando Ricerca Salute 2018