Confidence in the Use of Direct Oral Anticoagulants in the Acute Phase of Nonvalvular Atrial Fibrillation–Related Ischemic Stroke Over the Years: A Real-World Single-Center Study

Anticoagulation in the early phase of non-valvular atrial fibrillation-related acute ischemic stroke: where do we stand?

“…Age, severe neurological sequelae and renal impairment were associated with failure to prescribe DOACs. 18 Similar results were found by Deguchi et al who found that warfarin use at admission, higher mRS score and renal impairment were associated with failure to prescribe DOACs. 28 In the study by Moroni et al it was observed that the delay in DOACs introduction was associated with infarct size.…”

“…In a previous study performed in the Internal Medicine Ward of Santa Maria Nuova Hospital, Florence, Italy, Moroni et al demonstrated that in the era of DOACs the percentage of patients with NVAF-related AIS who underwent anticoagulation before hospital discharge was 69.5% and this percentage increased from 62.5% in 2014 to 88% in 2016. 18 In this study, enclosed with the review by Masotti et al, 90-day stroke recurrence, intracranial bleeding and all-cause mortality were 1%, 0% and 3% respectively. In the study by Moroni et al median mRS at hospital discharge and after 90-day in patients receiving DOACs was 3 (1-4) and 2 (1-3), respectively.…”

“…Moreover, the delay of DOACs starting was associated with NIHSS score. Patients with NIHSS scores <8 received DOACs with a delay of 4.1±3.1 days, those with NIHSS scores in the range 8-16 with a delay of 6.7±3.7 days, and the delay for patients with NIHSS scores >16 was 6.5±3.8 days 18 ). Similar results were found by Deguchi et al 29 in the SAMURAI Study in which the delay of DOACs introduction was associated with severity of stroke and by Macha et al who found that the delay in DOACs starting time was associated with infarct size and localization.…”

“…Only studies including DOACs and reporting endpoints, such as 90-day TIA/stroke recurrence, HT or intracranial bleeding and all-cause mortality were considered for the analysis. The Authors identified eight studies [18][19][20][21][22][23][24][25] satisfying the criteria of their search, with different methodology (five prospective observational, two retrospective and one prospective, open label, single arm design). Overall, the eight studies included 2187 patients (49.3% females) of whom 830 were treated with rivaroxaban, 729 with dabigatran, 475 with apixaban and 6 with edoxaban.…”

Use of oral anticoagulants and its associated factors among nonvalvular atrial fibrillation patients with new‐onset acute ischemic stroke: A report from the China Atrial Fibrillation Registry study

“…However, the initiation rate of OAC in our study is much lower than that in developed countries (69.5% in Germany, 74.5% in RAFstudy, and 69.5% in Italy). [15][16][17] In China, efforts are still needed to improve adherence of OAC therapy for NVAF patients with newonset AIS to reduce their risk of stroke recurrence.…”