Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation Article Swipe
Thomas R. Meinel
,
Mattia Branca
,
Gian Marco De Marchis
,
Krassen Nedeltchev
,
Timo Kahles
,
Leo H. Bonati
,
Marcel Arnold
,
Mirjam R. Heldner
,
Simon Jung
,
Emmanuel Carrera
,
Elisabeth Dirren
,
Patrik Michel
,
Davide Strambo
,
Carlo W. Cereda
,
Giovanni Bianco
,
Georg Kägi
,
Jochen Vehoff
,
Mira Katan
,
Manuel Bolognese
,
Roland Backhaus
,
Stephan Salmen
,
Sylvan Albert
,
Friedrich Medlin
,
Christian Berger
,
Ludwig Schelosky
,
Susanne Renaud
,
Julien Niederhäuser
,
Christophe Bonvin
,
Michael Schaerer
,
Marie‐Luise Mono
,
Biljana Rodic
,
Alexander A. Tarnutzer
,
Pasquale Mordasini
,
Jan Gralla
,
Johannes Kaesmacher
,
Stefan T. Engelter
,
Urs Fischer
,
David Seiffge
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1002/ana.25917
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1002/ana.25917
Objective The aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3‐month outcomes. Methods This was a cohort study of consecutive patients (2014–2019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0–2) at 3 months. Results Of 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2–11]) compared with VKA (6, [2–14]) and controls (7, [3–15], p < 0.001; quantile regression: β −2.1, 95% confidence interval [CI] −2.6 to −1.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50–0.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05–0.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6–4.7%) of controls, 9 of 195 (4.6%; 1.9–9.2%; aOR 0.93; 95% CI 0.46–1.90) patients on VKA and 2 of 65 (3.1%; 0.4–10.8%, aOR 0.56; 95% CI 0.28–1.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3‐month outcome (aOR 1.24; 1.01–1.51). Interpretation Prior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3 months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2021;89:42–53
Related Topics
Concepts
Medicine
Atrial fibrillation
Interquartile range
Modified Rankin Scale
Internal medicine
Stroke (engine)
Odds ratio
Thrombolysis
Confidence interval
Cardiology
Warfarin
Vitamin K antagonist
Ischemic stroke
Myocardial infarction
Ischemia
Mechanical engineering
Engineering
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1002/ana.25917
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ana.25917
- OA Status
- hybrid
- Cited By
- 121
- References
- 41
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3090358347
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W3090358347Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1002/ana.25917Digital Object Identifier
- Title
-
Prior Anticoagulation in Patients with Ischemic Stroke and Atrial FibrillationWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2020Year of publication
- Publication date
-
2020-09-30Full publication date if available
- Authors
-
Thomas R. Meinel, Mattia Branca, Gian Marco De Marchis, Krassen Nedeltchev, Timo Kahles, Leo H. Bonati, Marcel Arnold, Mirjam R. Heldner, Simon Jung, Emmanuel Carrera, Elisabeth Dirren, Patrik Michel, Davide Strambo, Carlo W. Cereda, Giovanni Bianco, Georg Kägi, Jochen Vehoff, Mira Katan, Manuel Bolognese, Roland Backhaus, Stephan Salmen, Sylvan Albert, Friedrich Medlin, Christian Berger, Ludwig Schelosky, Susanne Renaud, Julien Niederhäuser, Christophe Bonvin, Michael Schaerer, Marie‐Luise Mono, Biljana Rodic, Alexander A. Tarnutzer, Pasquale Mordasini, Jan Gralla, Johannes Kaesmacher, Stefan T. Engelter, Urs Fischer, David SeiffgeList of authors in order
- Landing page
-
https://doi.org/10.1002/ana.25917Publisher landing page
- PDF URL
-
https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ana.25917Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ana.25917Direct OA link when available
- Concepts
-
Medicine, Atrial fibrillation, Interquartile range, Modified Rankin Scale, Internal medicine, Stroke (engine), Odds ratio, Thrombolysis, Confidence interval, Cardiology, Warfarin, Vitamin K antagonist, Ischemic stroke, Myocardial infarction, Ischemia, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
121Total citation count in OpenAlex
- Citations by year (recent)
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2025: 29, 2024: 30, 2023: 30, 2022: 17, 2021: 15Per-year citation counts (last 5 years)
- References (count)
-
41Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| cited_by_percentile_year.min | 99 |
| corresponding_author_ids | https://openalex.org/A5076072571 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 38 |
| corresponding_institution_ids | https://openalex.org/I118564535, https://openalex.org/I2801112126 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.800000011920929 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.9870067 |
| citation_normalized_percentile.is_in_top_1_percent | True |
| citation_normalized_percentile.is_in_top_10_percent | True |