Journal Article

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

Simon Hellwig, Ulrike Grittner, Heinrich Audebert, Matthias Endres and Karl Georg Haeusler

in EP Europace

Published on behalf of European Society of Cardiology

Volume 20, issue 4, pages 569-574
Published in print April 2018 | ISSN: 1099-5129
Published online April 2017 | e-ISSN: 1532-2092 | DOI: https://dx.doi.org/10.1093/europace/eux087
Non-vitamin K-dependent oral anticoagulants have a positive impact on ischaemic stroke severity in patients with atrial fibrillation

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Abstract

Aims

Several 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 results

In 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.

Conclusion

NOAC 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.

Keywords: Atrial fibrillation; Ischaemic stroke; Morbidity; NOAC (Non-vitamin K oral anticoagulants); Stroke aetiology

Journal Article.  3631 words. 

Subjects: Cardiovascular Medicine

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