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

• Published in: Thrombosis and haemostasis Vol. 118; no. 12; p. 2145
• Main Authors: Jung, Yo Han, Choi, Hye-Yeon, Lee, Kyung-Yul, Cheon, Kyeongyeol, Han, Sang Won, Park, Joong Hyun, Cho, Han-Jin, Park, Hyung Jong, Nam, Hyo Suk, Heo, Ji Hoe, Lee, Hye Sun, Kim, Young Dae
• Format: Journal Article
• Language: English
• Published: Germany 01.12.2018
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Dabigatran - therapeutic use; Disease Progression; Drug Dosage Calculations; Drug Therapy, Combination; Female; Humans; Korea - epidemiology; Male; Middle Aged; Pyrazoles - therapeutic use; Pyridones - therapeutic use; Rivaroxaban - therapeutic use; Severity of Illness Index; Stroke - drug therapy; Stroke - epidemiology; Treatment Outcome; Warfarin - therapeutic use; Korea
• ISSN: 2567-689X
• DOI: 10.1055/s-0038-1675602

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.  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 (  = 219), (2) only anti-platelet (  = 347), (3) warfarin with a sub-therapeutic intensity (  = 185), (4) warfarin with a therapeutic intensity (  = 37), (5) under-dosed NOAC (  = 27) and (6) standard-dosed NOAC (  = 43). We compared the initial stroke severity between groups.  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 (  < 0.05). Multivariate analysis demonstrated that the NIHSS score was significantly low in the patients on warfarin with a therapeutic intensity ( , -5.602; 95% confidence interval [CI], -8.636 to -2.568;  < 0.001) or those on standard-dosed NOACs ( , -3.588; 95% CI, -6.405 to -0.771;  = 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.  Use of warfarin with a therapeutic intensity or standard-dosed NOACs was associated with a relatively mild stroke in the patients with NVAF.