Non-vitamin K-dependent oral anticoagulants have a positive impact on ischaemic stroke severity in patients with atrial fibrillation

Abstract

AimsSeveral studies showed reduced stroke severity in patients with atrial fibrillation (AF) if the international normalized ratio (INR) was ≥ 2 at stroke onset. There are no respective data for non-vitamin K-dependent oral anticoagulants (NOACs). The aim of this study was to compare the impact of NOAC or phenprocoumon intake on stroke severity.Methods and resultsIn this single-centre observational study, 3669 patients with acute ischaemic stroke were retrospectively analysed regarding AF status and medication immediately before admission. Using multivariable regression, we analysed the association of pre-admission anticoagulation with severe stroke (National Institutes of Health Stroke Scale score ≥ 11) on admission and poor outcome at discharge (modified Rankin scale score > 2). Before the index stroke, 655 patients had known AF and a CHA2DS2-VASc score ≥ 2. While 325 (49.6%) patients were anticoagulated, 159 (24.3%) were prescribed a NOAC and 75 (11.5%) phenprocoumon patients had an INR ≥ 2 on admission. Compared with AF patients without medical stroke prevention, an INR ≥ 2 [OR 0.23 (95% CI 0.10–0.53)] or NOAC intake [OR 0.48 (95% CI 0.27–0.86)] were associated with a lower probability of severe stroke after adjustment for confounders, while an INR < 2 [OR 0.62 (95% CI 0.33–1.16)] was not. Adjusted odds ratios for poor functional outcome at hospital discharge were 0.47 (95% CI 0.27–0.84) for NOAC patients, 0.33 (95% CI 0.17–0.65) for INR ≥ 2 and 0.61 (95% CI 0.32–1.16) for INR < 2.ConclusionNOAC intake before stroke did reduce the probability of severe stroke on hospital admission and poor functional outcome at hospital discharge as similarly demonstrated for phenprocoumon patients with an INR ≥ 2 on admission.

The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non‐valvular atrial fibrillation: ANITA‐FA study

“…Although few studies compare the severity and functional repercussion of stroke in patients receiving VKAs and DOACs, it does seem clear that appropriate anticoagulant therapy is associated with a greater probability of moderate or severe stroke and in-hospital mortality [15][16][17]. In our study, we observed that patients receiving treatment with DOACs were statistically significantly more likely to experience transient stroke and partial anterior circulation infarct than patients receiving VKAs, which are usually indicative of less severe infarcts and better functional outcomes.…”

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

“…A similar or even higher efficacy in preventing stroke compared to warfarin, together with a superior safety profile, has been shown for novel oral anticoagulants (NOAC) [9,10]. Moreover, a subsequent ischaemic stroke which occurs despite treatment with an oral anticoagulant is milder and has more favourable outcome [11].…”

Verlängertes EKG-Monitoring nach ischämischem Schlaganfall

“…In der überwiegenden Mehrzahl handelt es sich dabei um Vorhofflimmern, das etwa 2 % der deutschen Bevölkerung und vornehmlich ältere Menschen betrifft. Ein bestehendes paroxysmales, persistierendes oder permanentes Vorhofflimmern, das bei etwa 15-18 % aller Patienten bereits vor Auftreten eines akuten ischämischen Schlaganfalls bekannt ist [8][9], erhöht das Schlaganfallrisiko im Vergleich zur Allgemeinbevölkerung um das 4-bis 5-Fache. Derzeit ist davon auszugehen, dass etwa 15-20 % aller ischämischen Schlaganfälle durch Vorhofflimmern verursacht werden [10], das bei etwa 4-13 % aller Schlaganfallpatienten erstmals in der Akutphase des Schlaganfalls detektiert wird [8,[11][12].…”