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Non-vitamin K oral anticoagulants as first-line regimen for acute ischemic stroke with non-valvular atrial fibrillation

Authors
 Chan Wook Park  ;  Hyo Suk Nam  ;  Ji Hoe Heo  ;  Hyung Jong Park  ;  Jin Kyo Choi  ;  Hye Sun Lee  ;  Han Kyu Na  ;  Young Dae Kim 
Citation
 JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, Vol.29(9) : 105025, 2020-09 
Journal Title
 JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 
ISSN
 1052-3057 
Issue Date
2020-09
MeSH
Administration, Oral ; Aged ; Aged, 80 and over ; Anticoagulants / administration & dosage* ; Anticoagulants / adverse effects ; Atrial Fibrillation / complications ; Atrial Fibrillation / diagnosis ; Atrial Fibrillation / drug therapy* ; Brain Ischemia / diagnosis ; Brain Ischemia / drug therapy* ; Brain Ischemia / etiology ; Disability Evaluation ; Drug Substitution* / adverse effects ; Female ; Humans ; Intracranial Hemorrhages / chemically induced ; Male ; Middle Aged ; Platelet Aggregation Inhibitors / administration & dosage* ; Platelet Aggregation Inhibitors / adverse effects ; Recovery of Function ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke / diagnosis ; Stroke / drug therapy* ; Stroke / etiology ; Time Factors ; Treatment Outcome ; Warfarin / administration & dosage* ; Warfarin / adverse effects
Keywords
Anticoagulant ; Atrial fibrillation ; Cerebral infarction ; Outcome
Abstract
Purpose: There are various patterns in determining the choice of the first-line antithrombotic agent for acute stroke with non-valvular atrial fibrillation. We investigated the efficacy and safety of non-vitamin K oral anticoagulants as first-line antithrombotics for patients with acute stroke and non-valvular atrial fibrillation. Materials and methods: Patients with non-valvular atrial fibrillation and ischemic stroke or transient ischemic attack within 24 h from stroke onset were included. On the basis of the first regimen used and the regimen within 7 days after admission, the study population was divided into three groups: 1) antiplatelet switched to warfarin (A-W), 2) antiplatelet switched to NOAC (A-N), and 3) NOAC only (N only). We compared the occurrence of early neurologic deterioration, symptomatic intracranial hemorrhage, systemic bleeding, and poor functional outcome at 90 days. Results: Of 314 included patients, 164, 53, and 97 were classified into the A-W, A-N, and N only groups, respectively. Early neurologic deterioration was most frequently observed in the A-W group (9.1%), followed by the A-N (5.7%) and N only (1.0%) groups (p = 0.017). Multivariable analysis adjusting for potential confounders demonstrated that the N only group was independently associated with a lower rate of early neurologic deterioration (odds ratio [OR] 0.104, 95% CI 0.013-0.831) or poor functional outcome at 90 days (OR 0.450, 95% CI 0.215-0.940) than the A-W group. However, the rate of symptomatic intracranial hemorrhage or any systemic bleeding event did not differ among the groups. Conclusion: Using non-vitamin K oral anticoagulants as the first-line regimen for acute ischemic stroke may help prevent early neurologic deterioration without increasing the bleeding risk.
Full Text
https://www.sciencedirect.com/science/article/pii/S1052305720304432
DOI
10.1016/j.jstrokecerebrovasdis.2020.105025
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Physiology (생리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Park, Chan Wook(박찬욱) ORCID logo https://orcid.org/0000-0002-0208-5189
Park, Hyungjong(박형종)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180145
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