Ischaemic stroke and transient ischaemic attack on anticoagulants: outcomes in the era of direct oral anticoagulants

Abstract

Clinical and imaging characteristics of patients receiving direct oral anticoagulants presenting with transient ischaemic attack or stroke are lacking. A retrospective review of all patients who presented to a high-volume primary stroke centre with acute stroke symptoms while prescribed an oral anticoagulant between January 2012 and June 2017. Clinical, radiological characteristics and functional outcomes were examined. Anticoagulated patients diagnosed with stroke or transient ischaemic attack shared similar disease and outcome characteristics irrespective of anticoagulants used. One-third of warfarin patients with sub-therapeutic international normalised ratios were treated with thrombolytics but no direct oral anticoagulants level was performed in any of the patients, with only one treated by intravenous thrombolysis.

Effect of Total Phenolic Acid on the Repeated Cerebral Ischemia-Reperfusion Model in Mice

“…Qi deficiency, blood stasis and heat toxicity are important factors influencing the occurrence of disease (Xu et al, 2018). The relationship between the syndrome components of the combination analysis found that the cerebral ischemic factor was the most common syndrome of qi deficiency and turbidity (Valente et al, 2018). Western medicine believes that the pathogenesis of cerebral ischemic diseases is complex, including inflammation, cell damage amongst others (Zou et al, 2017).…”

Analysis of the posterior cerebral perfusion status and clinical prognostic value in chronic unilateral middle cerebral artery occlusion using SWAN combined with 3D-ASL

“…The incidence of ischemic cerebrovascular events within 12 months of enrollment, including transient ischemic attacks (TIAs) and AIS, was monitored. [8][9][10]…”

Trends in direct oral anticoagulant use in patients presenting with acute stroke

“…Across recent pooled international data, 22.5% of patients who had an ischaemic stroke had been receiving anticoagulant therapy prior to stroke onset, with approximately 13% on DOACs and 72% on warfarin 4 . We previously showed that over a 5‐year period from 2012 to 2017, one third of warfarinised patients with acute stroke were thrombolysed due to subtherapeutic international normalised ratio (INR) levels on presentation (INR ≤ 1.7) compared to only 1 out of the 19 patients taking DOACs who had received thrombolysis 5 . The lack of acute DOAC‐level testing was identified as one of the potential barriers to providing intravenous thrombolysis to patients presenting with stroke while on DOACs.…”

“…4 We previously showed that over a 5-year period from 2012 to 2017, one third of warfarinised patients with acute stroke were thrombolysed due to subtherapeutic international normalised ratio (INR) levels on presentation (INR ≤ 1.7) compared to only 1 out of the 19 patients taking DOACs who had received thrombolysis. 5 The lack of acute DOAC-level testing was identified as one of the potential barriers to providing intravenous thrombolysis to patients presenting with stroke while on DOACs. This may be further attributed to the lack of awareness of such assays by front-line clinicians, perceived delays to decision-making and the limited Conflict of interest: None.…”