Frontiers in Neurology | |
Impact of Non-vitamin K Antagonist Oral Anticoagulant Withdrawal on Stroke Outcomes | |
Hye Sun Lee1  Yo Han Jung2  Kyeongyeol Cheon3  Kyung-Yul Lee3  Joong Hyun Park4  Sang Won Han4  Hye-Yeon Choi5  Han-Jin Cho6  Young Dae Kim7  Ji Hoe Heo7  Hyo Suk Nam7  Hyung Jong Park7  Gustavo Saposnik8  | |
[1] Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea;Department of Neurology, Changwon Fatima Hospital, Changwon, South Korea;Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea;Department of Neurology, Inje University College of Medicine, Seoul, South Korea;Department of Neurology, Kyung Hee University School of Medicine, Kyung Hee University Hospital, Seoul, South Korea;Department of Neurology, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, South Korea;Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea;Stroke Outcomes and Decision Neuroscience Research Unit, Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; | |
关键词: stroke; non-valvular atrial fibrillation; outcome; cardiac embolism; anticoagulation; | |
DOI : 10.3389/fneur.2018.01095 | |
来源: DOAJ |
【 摘 要 】
Introduction: Discontinuation of oral anticoagulants such as non-vitamin K antagonist oral anticoagulants (NOACs) may induce a hypercoagulable state, leading to severe stroke and poor outcomes. This study aimed to compare stroke outcomes between NOACs withdrawal and other prior medication statuses in patients with non-valvular atrial fibrillation (NVAF).Methods: Consecutive patients who had pre-existing NVAF and were admitted for an acute ischemic stroke or transient ischemic attack- at five hospitals between January 2013 and December 2016 were included. Prior medication status was categorized into seven groups such as no antithrombotics, antiplatelet-only, warfarin with subtherapeutic intensity, warfarin with therapeutic intensity, NOAC, warfarin withdrawal, and NOAC withdrawal. We compared initial National Institute of Health Stroke Scale (NIHSS) scores between groupsResults: Among 719 patients with NVAF, The median NIHSS score at admission was 5 (IQR 1-13). The NOAC withdrawal group had the highest median NIHSS scores at stroke onset [16, interquartile range, IQR (1–17)], followed by the warfarin withdrawal group [11, IQR (1–14, 18)], the no antithrombotic group [5, IQR (1–13, 18, 19)], and the warfarin with subtherapeutic intensity group [5, IQR (1–10, 18, 19)]. A Multivariable analysis demonstrated that NOAC withdrawal was independently associated with higher NIHSS scores at stroke onset (B 4.645, 95% confidence interval 0.384–8.906, P = 0.033). The median interval from drug withdrawal to ischemic stroke or TIA was 7 days (IQR 4-15) in the NOAC group.Conclusions: Stroke that occurred after stopping oral anticoagulants, especially NOAC, and was more severe at presentation and associated with poorer outcomes.
【 授权许可】
Unknown