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01-09-2019 | Stroke | Original Communication

Stroke severity in patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists

Authors: Elias Auer, Sebastién Frey, Johannes Kaesmacher, Arsany Hakim, David J. Seiffge, Martina Goeldlin, Marcel Arnold, Urs Fischer, Simon Jung, Thomas Raphael Meinel

Published in: Journal of Neurology | Issue 9/2019

Abstract

Background

Although direct oral anticoagulants (DOAC) have proven at least equally effective in the prevention of acute ischemic stroke (AIS) in patients with atrial fibrillation as compared to the vitamin K antagonists (VKA), no reliable data on the severity of AIS of DOAC patients as compared to VKA is available.

Methods

Using a prospectively collected cohort of AIS patients, we performed univariate and multivariate (displayed as adjusted Odds Ratios, OR and 95% confidence intervals, 95% CI) analyses regarding the severity of AIS in patients with preceding DOAC (N = 210) versus VKA (N = 173) therapy. Additionally, we provide a sensitivity analysis considering only patients with warranted therapeutic anticoagulation activity.

Findings

In a comprehensive stroke center population, the frequency of AIS under DOAC was multiple times higher than previously reported at around 6% of all AIS and steadily increasing. National Institute of Health Stroke Scale (NIHSS) in VKA patients (median 7, IQR 2–14) was equal to DOAC (median 5, IQR 2–16) on univariate analysis (P = 0.229). According to the multivariable linear logistic regression analysis adjusting for confounders of severe stroke, VKA was not significantly associated with higher NIHSS scores (β − 0.165, 95% CI − 1.874 to 1.545, P = 0.850) as compared to DOAC. Also in the sensitivity analysis considering only patients with warranted therapeutic OAC therapy, VKA was not significantly associated with higher NIHSS scores (β − 1.392, 95% CI − 3.506 to 0.721, P = 0.195) as compared to DOAC. However, VKA as compared to DOAC was significantly associated with lower rates of good functional outcome at three months (0.527, 95% CI 0.300–0.928), but not with increased mortality (aOR 1.825, 95% CI 0.780–4.273).

Interpretation

Ischemic stroke in patients taking DOAC is an important and frequent scenario. Stroke severity in our real world population dataset is equal in patients taking VKA and DOAC, also in the case of warranted anticoagulation therapy. Preceding VKA as compared to DOAC was associated with lower rates of good functional outcome without excess mortality, but a causal relationship cannot be proven by our study design.

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Title: Stroke severity in patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists
Authors: Elias Auer
Sebastién Frey
Johannes Kaesmacher
Arsany Hakim
David J. Seiffge
Martina Goeldlin
Marcel Arnold
Urs Fischer
Simon Jung
Thomas Raphael Meinel
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Direct Oral Anticoagulant
Atrial Fibrillation
Direct Oral Anticoagulant
Published in: Journal of Neurology / Issue 9/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09412-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stroke severity in patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists

Abstract

Background

Methods

Findings

Interpretation

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Findings

Interpretation

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