Impact of Non-vitamin K Antagonist Oral Anticoagulant Withdrawal on Stroke Outcomes

Frontiers in Neurology

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