Highlights
- •Stroke severity was identical in pre-treated patients with direct and vitamin-K anticoagulants.
- •Infra-therapeutic anticoagulation was not associated with stoke severity.
- •High percentage of inappropriate low-dose in direct anticoagulants prescription.
- •Direct anticoagulants were associated with lower mortality and better functional outcome.
Abstract
Background and Purpose: Acute ischemic stroke (AIS) severity and clinical course are less known in direct
oral anticoagulants (DOAC) users. We aimed to explore the outcome of AIS in patients
pretreated with vitamin-K-antagonists (VKA) and DOAC. Methods: A retrospective study was performed. Patients pretreated with oral anticoagulants
(OAC) for nonvalvular atrial fibrillation admitted for AIS in a stroke unit between
2016-01-01 and 2018-08-31 were included. The primary endpoint was mortality during
the hospital stay, and secondary endpoints were neurologic improvement at stroke unit
discharge and good functional outcome 90 days after AIS. Results: A total of 156 patients were included (83 on VKA and 73 on DOAC). Stroke severity
(defined by NIHSS on admission) was comparable in both groups (AVK 13.0 [4.0-20.0]
versus DOAC 11.0 [4.0-17.0], P = .435). Infratherapeutic levels and/or inappropriate low dose of OAC was also similar
between groups (P = .152) and was not associated with stroke severity (P = .631) or mortality (P = .788). VKA (OR 12.616, P = .035, 95%CI 1.19-133.64) and PH2 hemorrhagic transformation (OR 7.516, P = .024, 95%CI 1.31-43.20) were associated with higher mortality in multivariate analysis.
Higher stroke severity (OR .101, P < .001, 95%CI .037-.279) and VKA usage (OR .212, P = .003, 95%CI .08-.58) were associated with worse functional outcome at 3 months.
Reperfusion therapy was significantly associated with neurologic improvement during
stroke unit stay (OR 3.969, P = .009, 95%CI 1.42-11.11) but not with the functional outcome (P = .063). Conclusions: Nonvalvular atrial fibrillation patients pretreated with DOAC admitted for AIS had
a better outcome when compared to VKA, although stroke severity was similar between
groups.
Key Words
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Article info
Publication history
Published online: February 14, 2020
Accepted:
January 23,
2020
Received in revised form:
January 21,
2020
Received:
November 16,
2019
Footnotes
Funding: No funding was received for this study.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104691
Copyright
© 2020 Elsevier Inc. All rights reserved.
