Association Between Oral Anticoagulants and Stroke Severity at Onset in Elderly Patients with Cardioembolic Stroke Due to Non-Valvular Atrial Fibrillation

Deguchi, Ichiro; Osada, Takashi; Takahashi, Shinichi

doi:10.1016/j.jstrokecerebrovasdis.2021.106264

Cited by 1 publication

(3 citation statements)

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“…Anticoagulant therapy is key to preventing stroke in patients with AF. Moreover, studies have found that patients with prior oral anticoagulant therapy who developed ischemic stroke had milder symptoms and better prognosis than those without prior anticoagulant treatment 13,14 . Our results showed a similar phenomenon in the Chinese population, suggesting that the adequacy of anticoagulant therapy is closely related to stroke severity and short-term outcome.…”

Section: Discussionsupporting

confidence: 76%

“…Moreover, studies have found that patients with prior oral anticoagulant therapy who developed ischemic stroke had milder symptoms and better prognosis than those without prior anticoagulant treatment. 13,14 Our results showed a similar phenomenon in the Chinese population, suggesting that the adequacy of anticoagulant therapy is closely related to stroke severity and short-term outcome. We found that patients with adequate prior anticoagulant therapy had milder stroke severity, lower rates of massive infarction, and better outcomes at discharge.…”

Section: Discussionsupporting

confidence: 71%

“…Fernandes et al 13 found that among 60 patients with NVAF, stroke occurred even after receiving anticoagulant therapy, which may be due to insufficient dosage, poor treatment compliance, or noncardiac embolism. Deguchi et al 14 reported that elderly patients with NVAF who received oral anticoagulation therapy had milder symptoms and better disease prognosis at the onset of cerebral infarction than those who did not. More interestingly, studies have shown that patients taking DOACs have reduced infarct volume and modified Rankin Scale (mRS) scores compared with patients taking other medications 15 .…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and Mechanism of Acute Ischemic Stroke in NAVF Patients With Prior Oral Anticoagulant Therapy

Xue

Dong

et al. 2023

The Neurologist

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Objectives: We aimed to analyze the characteristics and mechanisms of acute ischemic stroke (AIS) in patients with nonvalvular atrial fibrillation (NVAF) who received prior anticoagulant therapy. Methods: We retrospectively analyzed the data of patients with NVAF and AIS between January 2016 and December 2021. Patients were divided into non-anticoagulant, adequate anticoagulant, and insufficient anticoagulant groups according to their prior anticoagulant status. Patients with prior anticoagulant therapy were further divided into warfarin and direct oral anticoagulant groups. Results: A total of 749 patients (661 without anticoagulants, 33 with adequate anticoagulants, and 55 with insufficient anticoagulants) were included. Patients with adequate anticoagulant had a milder National Institute of Health Stroke Scale at presentation (P=0.001) and discharge (P=0.003), a higher proportion of Modified Rankin Scale (mRS) ≤2 at discharge (P=0.011), and lower rates of massive infarction (P=0.008) than patients without anticoagulant. Compared with the non-anticoagulant group, the proportion of intravenous thrombolysis was significantly lower in the adequate anticoagulant (P<0.001) and insufficient anticoagulant (P=0.009) groups. Patients in the adequate anticoagulant group had higher rates of responsible cerebral atherosclerotic stenosis (P=0.001 and 0.006, respectively) and competing large artery atherosclerotic mechanisms (P=0.006 and 0.009, respectively) than those in the other 2 groups. Compared with warfarin, direct oral anticoagulant was associated with higher rates of Modified Rankin Scale ≤2 at discharge (P=0.003). Conclusions: Adequate anticoagulant therapy may be associated with milder stroke severity and better outcomes at discharge in patients with NVAF. Competing large artery atherosclerotic mechanisms may be associated with anticoagulant failure in patients with NAVF with prior adequate anticoagulant therapy.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 71%