Clinical Features, Management, and Recurrence of Acute Ischemic Stroke Occurring in Patients on Oral Anticoagulant Treatment for Nonvalvular Atrial Fibrillation: A Real-World Retrospective Study.

IF 1.1 4区 医学 Q4 CLINICAL NEUROLOGY Neurologist Pub Date : 2024-11-01 DOI:10.1097/NRL.0000000000000579
Elisa Grifoni, Beatrice Pagni, Teresa Sansone, Mariella Baldini, Elisabetta Bertini, Sara Giannoni, Ilaria Di Donato, Irene Sivieri, Gina Iandoli, Marianna Mannini, Elisa Giglio, Vincenzo Vescera, Eleonora Brai, Ira Signorini, Eleonora Cosentino, Irene Micheletti, Elisa Cioni, Giulia Pelagalli, Alessandro Dei, Antonio Giordano, Francesca Dainelli, Mario Romagnoli, Chiara Mattaliano, Elena Schipani, Giuseppe Salvatore Murgida, Stefania Di Martino, Valentina Francolini, Luca Masotti
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Abstract

Objectives: The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA for nonvalvular atrial fibrillation (NVAF).

Methods: We retrospectively analyzed data on NVAF patients with AIS on direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) admitted to our Stroke Unit from 2017 to 2022. Ninety-day modified Rankin Scale (mRS), 90-day, and 12-month stroke recurrences were recorded.

Results: A total of 169 patients (53.2% female, mean age 82.8±6.7 y), 117 (69.2%) on DOAC, and 52 on VKA (30.8%), were enrolled. Mean age, in-hospital mortality, and 90-day mRS ≥4 were significantly higher in VKA patients. 63.4% of VKA patients had subtherapeutic INR, whereas 47.1% of DOAC patients were on low-dose (14.2% off-label). Large vessel occlusion and embolic etiology were more frequent in VKA patients (34.6% vs. 26.4%, P =0.358; 92.3% vs. 74.3%, P =0.007, respectively), whereas lacunar strokes were more frequent in DOAC patients (19.8% vs. 12.2%, P =0.366). Among patients on VKA before AIS 86.4% were switched to DOAC, whereas a DOAC-to-VKA and a DOAC-to-DOAC switch were done in 25.4% and 11.7%, respectively. Stroke recurrence occurred in 6.4% of patients at 90 days and 10.7% at 12 months. Anticoagulant switching was not associated with stroke recurrences.

Conclusions: In our study, nonembolic etiology was more frequent in DOAC patients and anticoagulant switching did not reduce the risk of stroke recurrence. Prospective multicentric studies are warranted.

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口服抗凝剂治疗非瓣膜性心房颤动患者急性缺血性卒中的临床特征、处理和复发:一项真实世界的回顾性研究
目的:口服抗凝药(OA)患者急性缺血性卒中(AIS)的最佳治疗具有挑战性。我们的研究旨在分析非瓣膜性心房颤动(NVAF)OA 患者 AIS 的临床特征和预后:我们回顾性分析了2017年至2022年期间卒中科收治的服用直接口服抗凝药(DOAC)或维生素K拮抗剂(VKA)的非瓣膜性心房颤动(NVAF)AIS患者的数据。记录了90天改良Rankin量表(mRS)、90天和12个月的卒中复发情况:共纳入 169 名患者(53.2% 为女性,平均年龄(82.8±6.7)岁),其中 117 人(69.2%)使用 DOAC,52 人(30.8%)使用 VKA。VKA患者的平均年龄、院内死亡率和90天mRS≥4明显更高。63.4%的VKA患者INR低于治疗水平,而47.1%的DOAC患者为低剂量(14.2%为标签外)。大血管闭塞和栓塞病因在 VKA 患者中更为常见(分别为 34.6% 对 26.4%,P=0.358;92.3% 对 74.3%,P=0.007),而腔隙性脑卒中在 DOAC 患者中更为常见(19.8% 对 12.2%,P=0.366)。在 AIS 前使用 VKA 的患者中,86.4% 转用 DOAC,而 DOAC 转 VKA 和 DOAC 转 DOAC 的比例分别为 25.4% 和 11.7%。6.4% 的患者在 90 天内和 10.7% 的患者在 12 个月内中风复发。抗凝剂转换与中风复发无关:在我们的研究中,非栓塞性病因在 DOAC 患者中更为常见,抗凝剂转换并未降低卒中复发风险。有必要进行前瞻性多中心研究。
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来源期刊
Neurologist
Neurologist 医学-临床神经学
CiteScore
1.90
自引率
0.00%
发文量
151
审稿时长
2 months
期刊介绍: The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.
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