Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose

Yo Han Jung; Hye-Yeon Choi; Kyung-Yul Lee; Kyeongyeol Cheon; Sang Won Han; Joong Hyun Park; Han-Jin Cho; Hyung Jong Park; Hyo Suk Nam; Ji Hoe Heo; Hye Sun Lee; Young Dae Kim

doi:10.1055/s-0038-1675602

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2018; 118(12): 2145-2151
DOI: 10.1055/s-0038-1675602

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose

Authors

Yo Han Jung

¹Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
Hye-Yeon Choi

²Department of Neurology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
Kyung-Yul Lee

³Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
Kyeongyeol Cheon

³Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
Sang Won Han

⁴Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Joong Hyun Park

⁴Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Han-Jin Cho

⁵Department of Neurology, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
Hyung Jong Park

⁶Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
Hyo Suk Nam

⁶Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
Ji Hoe Heo

⁶Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
Hye Sun Lee

⁷Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Young Dae Kim

⁶Department of Neurology, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background The stroke severity or functional outcomes could differ because the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) could be different according to the dose. We investigated whether there was any difference in the stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) by their prior medication status, including standard-dosed versus under-dosed NOACs.

Materials and Methods We enrolled 858 patients with acute ischaemic stroke with chronic NVAF admitted at six hospitals in Korea. We categorized their prior medication status as follows: (1) no anti-thrombotics (n = 219), (2) only anti-platelet (n = 347), (3) warfarin with a sub-therapeutic intensity (n = 185), (4) warfarin with a therapeutic intensity (n = 37), (5) under-dosed NOAC (n = 27) and (6) standard-dosed NOAC (n = 43). We compared the initial stroke severity between groups.

Results Among the 858 patients, the patients on standard-dosed NOACs had the lowest initial National Institute of Health Stroke Scale (NIHSS) score, followed by those on warfarin with a therapeutic intensity and those on only anti-platelet (p < 0.05). Multivariate analysis demonstrated that the NIHSS score was significantly low in the patients on warfarin with a therapeutic intensity (B, –5.602; 95% confidence interval [CI], –8.636 to –2.568; p < 0.001) or those on standard-dosed NOACs (B, –3.588; 95% CI, –6.405 to –0.771; p = 0.013), while there was no difference in the NIHSS score between the patients not taking any anti-thrombotics and those on warfarin with a sub-therapeutic intensity or under-dosed NOACs.

Conclusion Use of warfarin with a therapeutic intensity or standard-dosed NOACs was associated with a relatively mild stroke in the patients with NVAF.

Keywords

stroke - atrial fibrillation - outcome - NOAC

Full Text

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