Effects of dabigatran and rivaroxaban on stroke severity according to the results of routine coagulation tests

Cho, Han Jin; Kang, Yoon Jung; Sung, Sang Min; Ahn, Sung Hee; Jung, Yo Han; Lee, Ki Young; Seo, Jung Hwa; Han, Sang Won; Park, Joong Hyun; Choi, Hye Yeon; Kwon, Jee Hyun; Kim, Wook Joo; Park, Hyungjong; Choi, Jin Kyo; Nam, Hyo Suk; Heo, Ji Hoe

doi:10.1371/journal.pone.0240483

Cited by 3 publications

(2 citation statements)

References 32 publications

(51 reference statements)

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“…These results supported the thesis that the most important factor is dosage that aligns with drug characteristics [26]. Monitoring of apixaban and rivaroxaban has been performed in many studies [27][28][29][30].…”

Section: Discussionsupporting

confidence: 77%

Therapeutic monitoring of direct oral anticoagulants — an 8-year observational study

Grześk

2021

Acta Haematol Pol.

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Section: Discussionsupporting

confidence: 77%

Therapeutic monitoring of direct oral anticoagulants — an 8-year observational study

Grześk

2021

Acta Haematol Pol.

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“…It is logical that AF prevalence is lowest in IVT and highest in EVT, considering pertinent factors. AF patients often receive oral anticoagulant therapy [ 45 , 98 ] which can influence clotting markers [ 99 , 100 ] and contraindicate IVT due to bleeding risks [ 17 ]. EVT is recommended for large vessel occlusion (LVO) strokes [ 17 ], which often have a cardioembolic source, frequently AF, explaining the higher AF prevalence in patients receiving EVT [ 27 , 101 ].…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Reperfusion Therapy in Acute Ischaemic Stroke Patients: Prevalence and Outcomes—A Comprehensive Systematic Review and Meta-Analysis

Patel,

Bhaskar

2023

Neurology International

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Atrial fibrillation (AF) significantly contributes to acute ischaemic stroke (AIS), yet its precise influence on clinical outcomes post-intravenous thrombolysis (IVT) and post-endovascular thrombectomy (EVT) has remained elusive. Furthermore, the overall prevalence of AF in AIS patients undergoing reperfusion therapy has not been clearly determined. Employing random-effects meta-analyses, this research aimed to estimate the pooled prevalence of AF among AIS patients undergoing reperfusion therapy, while also examining the association between AF and clinical outcomes such as functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. Studies comparing AF and non-AF patient groups undergoing reperfusion therapy were identified and included following an extensive database search. Forty-nine studies (n = 66,887) were included. Among IVT patients, the prevalence of AF was 31% (Effect Size [ES] 0.31 [95%CI 0.28–0.35], p < 0.01), while in EVT patients, it reached 42% (ES 0.42 [95%CI 0.38–0.46], p < 0.01), and in bridging therapy (BT) patients, it stood at 36% (ES 0.36 [95%CI 0.28–0.43], p < 0.01). AF was associated with significantly lower odds of favourable 90-day functional outcomes post IVT (Odds Ratio [OR] 0.512 [95%CI 0.376–0.696], p < 0.001), but not post EVT (OR 0.826 [95%CI 0.651–1.049], p = 0.117). Our comprehensive meta-analysis highlights the varying prevalence of AF among different reperfusion therapies and its differential impact on patient outcomes. The highest pooled prevalence of AF was observed in EVT patients, followed by BT and IVT patients. Interestingly, our analysis revealed that AF was significantly associated with poorer clinical outcomes following IVT. Such an association was not observed following EVT.

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The Impact of Prior Antithrombotic Use on Blood Viscosity in Cardioembolic Stroke with Non-Valvular Atrial Fibrillation

Jung

Han

Park

2023

JCM

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Although clinical studies have demonstrated that prior use of antiplatelets was associated with decreased blood viscosity (BV) in patients with acute ischemic stroke, the impact of previous anticoagulant use on blood viscosity in cardioembolic stroke with non-valvular AF (NVAF) has not yet been clearly studied. This single-center retrospective observational study aimed to determine the impact of prior antithrombotic (antiplatelet and anticoagulant) use on BV in patients with cardioembolic stroke (CES) due to NVAF. Patients with CES and NVAF were analyzed with the following inclusion criteria: (1) patients over 20 years of age admitted within five days of stroke onset; (2) ischemic stroke presumably due to an NVAF-derived embolus; (3) compatible cortical/subcortical lesion on brain computed tomography or magnetic resonance imaging; (4) hemoglobin level of 10–18 mg/dL; and (5) receiving antiplatelets within five days or anticoagulants within two days if previously medicated. From the screening of 195 patients (22% of the total stroke population during the study period) who had experienced ischemic stroke with AF, 160 were included for the final analysis. Eighty-nine patients (56%) were taking antithrombotics (antiplatelet, 57%; warfarin, 13%; NOACs, 30%) regularly. Compared to patients without previous antithrombotic use, those with previous antithrombotic use (antiplatelets, warfarin, and NOACs) were significantly associated with decreased systolic BV (SBV) and diastolic BV (DBV) (p < 0.036). In multiple linear regression analysis, hematocrit (Hct) level and prior antithrombotic use were significantly associated with decreased SBV and DBV. Hct was positively correlated with increased SBV and DBV. In Hct-adjusted partial correlation analysis, prior uses of any antithrombotic agents were associated with decreased SBV (r < −0.270, p < 0.015) and DBV (r < −0.183, p < 0.044). In conclusion, this study showed that prior antithrombotic use (antiplatelets, VKAs, and NOACs) was associated with decreased SBV and DBV in patients presenting with acute CES secondary to NVAF. Our results indicated that previous use of NOACs may be a useful hemorheological parameter in patients with acute CES due to NVAF. Accumulation of clinical data from a large number of patients with the risk of stroke occurrence, initial stroke severity, and functional outcome is necessary to assess the usefulness of BV.

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Effects of dabigatran and rivaroxaban on stroke severity according to the results of routine coagulation tests

Cited by 3 publications

References 32 publications

Therapeutic monitoring of direct oral anticoagulants — an 8-year observational study

Therapeutic monitoring of direct oral anticoagulants — an 8-year observational study

Atrial Fibrillation and Reperfusion Therapy in Acute Ischaemic Stroke Patients: Prevalence and Outcomes—A Comprehensive Systematic Review and Meta-Analysis

The Impact of Prior Antithrombotic Use on Blood Viscosity in Cardioembolic Stroke with Non-Valvular Atrial Fibrillation

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