Prior direct oral anticoagulant dosage and outcomes in patients with acute ischemic stroke and non-valvular atrial fibrillation: A sub-analysis of PASTA registry study

• Published in: Journal of the neurological sciences Vol. 434; p. 120163
• Main Authors: Mashiko, Takafumi, Fujimoto, Shigeru, Suda, Satoshi, Abe, Arata, Iguchi, Yasuyuki, Yagita, Yoshiki, Kanzawa, Takao, Okubo, Seiji, Todo, Kenichi, Yamazaki, Mineo, Nakajima, Nobuhito, Kondo, Kimito, Inoue, Takeshi, Iwanaga, Takeshi, Terasawa, Yuka, Shibazaki, Kensaku, Kimura, Kazumi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2022
• Subjects: Administration, Oral; Anticoagulants; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Humans; Ischemic Stroke; Kidney Diseases; Low-dose direct oral anticoagulants; Non-valuvular atrial fibrillation; Prospective Studies; Registries; Stroke - complications; Stroke - drug therapy; eGFR; NIHSS; Non-valuvular atrial fibrillation; AF; NVAF; PASTA; IS; Ischemic stroke; DOAC; TIA; ICH; mRS; Low-dose direct oral anticoagulants
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2022.120163

Prescribing under-dose direct oral anticoagulants (DOACs) for non-valvular atrial fibrillation (NVAF) is alerted to increase cardiovascular events or death. However, the association between dose selection of DOACs and the clinical course remains unclear. This study aimed to propose a novel criterion for selecting the DOAC dose and investigate clinical characteristics of ischemic stroke (IS) under this criterion. We assessed the pooled prospective multicenter registry data of stroke patients taking anticoagulant agents, including IS patients with NVAF and prior DOAC usage. The recommended dose according to the reduction criteria of each DOAC and the selected dose were identified for each patient, and patients were categorized into four groups: no alternative low-dose, selecting low-dose appropriately with all DOACs applicable for reduction criteria; selected low-dose, selecting low-dose appropriately or inappropriately despite at least one DOAC inapplicable for reduction criteria; selected standard-dose, appropriate standard-dose use; and absolute over-dose, inappropriate standard-dose regardless of criteria. We investigated the effects of dose selection of DOACs on short-term poor functional outcomes. 322 patients were included in the analysis. The prevalence of no alternative low-dose, selected low-dose, selected standard-dose, and absolute over-dose was 74 (23%), 144 (45%), 89 (27%), and 15 (5%), respectively. Multivariable analysis found that the selected low-dose group showed significantly poorer functional outcomes than the selected standard-dose group only in patients without renal dysfunction (OR, 2.60; 95% CI, 1.17–6.00; P = 0.0186). Selecting a low dose DOAC might be associated with poor functional outcomes in patients without renal dysfunction. [Display omitted] •Standard and low doses of direct oral anticoagulant available in clinical practice.•Proposing novel classifications for selecting doses of each direct oral anticoagulant.•Poor functional outcomes in normal kidney conditions with selecting low-dose DOAC.