Characteristics of Ischemic Versus Hemorrhagic Stroke in Patients Receiving Oral Anticoagulants: Results of the PASTA Study

Abstract

Objective Limited data exist regarding the comparative detailed clinical characteristics of patients with ischemic stroke (IS)/transient ischemic attack (TIA) and intracerebral hemorrhage (ICH) receiving oral anticoagulants (OACs). Methods The prospective analysis of stroke patients taking oral anticoagulants (PASTA) registry, a multicenter registry of 1,043 stroke patients receiving OACs (vitamin K antagonists [VKAs] or non-vitamin K oral antagonists [NOACs]) across 25 medical institutions throughout Japan, was used. Univariate and multivariable analyses were used to analyze differences in clinical characteristics between IS/TIA and ICH patients with atrial fibrillation (AF) who were registered in the PASTA registry. Results There was no significant differences in cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, smoking, or alcohol consumption (all p>0.05), between IS/TIA and ICH among both NOAC and VKA users. Cerebral microbleeds (CMBs) (odds ratio [OR], 4.77; p<0.0001) were independently associated with ICH, and high brain natriuretic peptide/N-terminal pro B-type natriuretic peptide levels (OR, 1.89; p=0.0390) were independently associated with IS/TIA among NOAC users. A history of ICH (OR, 13.59; p=0.0279) and the high prothrombin time-international normalized ratio (PT-INR) (OR, 1.17; p< 0.0001) were independently associated with ICH, and a history of IS/TIA (OR, 3.37; 95% CI, 1.34-8.49; p= 0.0101) and high D-dimer levels (OR, 2.47; 95% CI, 1.05-5.82; p=0.0377) were independently associated with IS/TIA among VKA users.

Trends in prior antithrombotic medication and risk of in-hospital mortality after spontaneous intracerebral hemorrhage: the J-ICH registry

“…Because real-world Japanese data indicated that the use of OACs was increasing and DOACs were rapidly replacing warfarin in patients with non-valvular atrial fibrillation 7 , these situations might result in an increment in the rate of prior DOAC users in Japanese SICH. Indeed, a prospective Japanese multi-stroke center cohort (the PASTA registry) that enrolled acute stroke patients receiving prior OAC from April 2016 to September 2019 showed a similar rate of prior OAC use in SICH (DOACs 73% vs warfarin 27%) 33 .…”

Acute Ischaemic Stroke in Patients Treated with Direct Oral Anticoagulants: Potential Causes, Clinical Characteristics, and Short-Term Outcomes

“…A study by Lin et al showed that patients with recurrent AIS despite DOAC therapy were more likely to suffer from a malignancy [ 34 ]. A study by Suda et al showed that high levels of B-type natriuretic peptide, suggestive of congestive heart failure, were independently associated with AIS or TIA despite the use of oral anticoagulants (DOAC or VKA) [ 35 ].…”