Anticoagulants, Reperfusion Therapy, and Outcomes in Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation　― A Single-Center, 6-Year Experience of 546 Consecutive Patients ―

Suda, Satoshi; Sakamoto, Yuki; Okubo, Seiji; Aoki, Junya; Shimoyama, Takashi; Kanamaru, Takuya; Suzuki, Kentaro; Kutsuna, Akihito; Matsumoto, Noriko; Nito, Chikako; Nishiyama, Yasuhiro; Mishina, Masayoshi; Kimura, Kazumi

doi:10.1253/circj.cj-18-0561

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…One of the reasons for the lower prescribing rate in our study was that DOACs were only approved for use in Japan in 2011, which was just before the present study period. The prescribing rate of DOACs has been increasing recently in Japan [26].…”

Section: Discussionmentioning

confidence: 99%

Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

et al. 2021

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Background and Purpose: Anticoagulant drugs, including vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs), can reduce stroke severity and are associated with good functional outcomes. Some patients are prescribed lower-than-recommended doses of DOACs; whether these have similar effects has not been clarified. Methods: We retrospectively evaluated 1,139 consecutive ischemic stroke and transient ischemic attack patients with atrial fibrillation. Patients were divided into 5 groups according to their preceding anticoagulant drug therapies: no anticoagulant therapy (ACn), undercontrolling VKA doses (VKAuc), recommended, controlling VKA doses (VKArec), prescribed underdoses of DOAC (DOACud), and recommended doses of DOAC (DOACrec). We investigated the associations between these anticoagulant drug therapies and patients’ initial stroke severity and 3-month outcomes. Results: Median National Institutes of Health Stroke Scale scores at admission were as follows: ACn: 16, VKAuc: 15, VKArec: 9, DOACud: 5, and DOACrec: 7. When the ACn group was used as a reference, regression analysis showed that VKArec (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.01–2.21), DOACud (OR 2.84, 95% CI: 1.47–5.66), and DOACrec (OR 1.83, 95% CI: 1.23–2.74) were associated with milder stroke severity, while VKAuc was not. Median 3-month modified Rankin Scale scores were 2 in the DOACud and DOACrec groups and 4 in all other groups. After adjusting for confounding factors, DOACud (OR 3.14, 95% CI: 1.50–6.57) and DOACrec (OR 1.67, 95% CI: 1.05–2.64) were associated with good 3-month outcomes while VKAuc and VKArec were not. Conclusions: In patients with atrial fibrillation, recommended doses and underdoses of DOACs reduced stroke severity on admission and were associated with good 3-month outcomes.

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Section: Discussionmentioning

confidence: 99%

Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

et al. 2021

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“…With device advances, the recanalization rate is now close to 90%. We reported that the mortality rate was radically decreased by t‐PA therapy and/or mechanical thrombectomy in patients with cardioembolic stroke 17 . In recent years, it has been shown that mechanical thrombectomy in selected patients is effective up to 24 hours after stroke onset.…”

Section: Mechanical Thrombectomymentioning

confidence: 97%

“…We reported that the mortality rate was radically decreased by t-PA therapy and/or mechanical thrombectomy in patients with cardioembolic stroke. 17 In recent years, it has been shown that mechanical thrombectomy in selected patients is effective up to 24 hours after stroke onset. In the future for acute stroke treatment, we suspect that mechanical thrombectomy will be suitable for patients with large vessel occlusion, while t-PA will be for those with peripheral vessel occlusion.…”

Section: Mechanic Al Thromb Ec Tomymentioning

confidence: 99%

Drastic changes in acute stroke treatment

Kimura

Nito

Nishiyama

et al. 2020

Neurology & Clinical Neurosc

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t‐PA therapy has been able to be performed based on RCT study results in the world from 25 years ago. However, the Japan government approved the use of t‐PA 15 years ago. In the last 15 years, diagnostic imaging and treatment for acute stroke have been changed remarkably. The appearance of diffusion‐weighted images as diagnostic imaging for acute stroke and mechanical thrombectomy as treatment for acute stroke can markedly improve patient outcome. We experienced many severe patients treated with such therapies discharged by walk. Therefore, we would like to emphasize that stoke treatment has been changed drastically. Unfortunately, at present, stroke patients who do not have benefit from t‐PA therapy and mechanical thrombectomy therapies are not so many. In order to solve those problems, we should need to establish a stroke medical care system in Japan as soon as possible. In this presentation, we will outline the image of acute stroke, acute treatment, and stroke medical care system.

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“…The use of reperfusion therapy, including mechanical thrombectomy [1] and intravenous thrombolysis with recombinant tissue plasminogen activator [2], has increased steadily, resulting in better clinical outcomes in acute stroke patients [3]. Subsequent therapy in rehabilitation facilities further improves outcomes and increases the rate of discharge to community care centers [4].…”

Section: Objectivementioning

confidence: 99%

The safety of rapid administration of enteral nutrition in acute stroke patients

Suzuki

Sugiyama

Katano

et al. 2022

Journal of the Neurological Sciences

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Anticoagulants, Reperfusion Therapy, and Outcomes in Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation　― A Single-Center, 6-Year Experience of 546 Consecutive Patients ―

Abstract: Inappropriate anticoagulant use for stroke patients with NVAF did not decrease over time. An increase in reperfusion therapy was a strong factor in improved functional outcomes and mortality.

Cited by 9 publications

References 22 publications

Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

Drastic changes in acute stroke treatment

The safety of rapid administration of enteral nutrition in acute stroke patients

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Anticoagulants, Reperfusion Therapy, and Outcomes in Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation ― A Single-Center, 6-Year Experience of 546 Consecutive Patients ―

Abstract: Inappropriate anticoagulant use for stroke patients with NVAF did not decrease over time. An increase in reperfusion therapy was a strong factor in improved functional outcomes and mortality.

Cited by 9 publications

References 22 publications

Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

Drastic changes in acute stroke treatment

The safety of rapid administration of enteral nutrition in acute stroke patients

Contact Info

Product

Resources

About

Anticoagulants, Reperfusion Therapy, and Outcomes in Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation　― A Single-Center, 6-Year Experience of 546 Consecutive Patients ―