Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose
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 (NV...
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Published in | Thrombosis and haemostasis Vol. 118; no. 12; p. 2145 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Germany
01.12.2018
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Subjects | |
Online Access | Get more information |
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Summary: | 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. |
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ISSN: | 2567-689X |
DOI: | 10.1055/s-0038-1675602 |