Infarct Volumes of Patients with Acute Ischemic Stroke Receiving Direct Oral Anticoagulants due to Non-Valvular Atrial Fibrillation

Abstract

Direct oral anticoagulants (DOACs) have been shown to decrease the risk of ischemic stroke in non-valvular atrial fibrillation (NVAF). This study aims to investigate whether DOACs result in a significant change in lesion volume and the severity of the subsequent disability in patients who have experienced a stroke. Methods: The study included a total of 137 patients with NVAF and acute stroke. The cohort included 76 patients using DOACs, 21 patients using acetylsalicylic acid (ASA), and 40 patients with newly diagnosed atrial fibrillation (NDAF) who did not use antiaggregants or anticoagulants. Diffusion-weighted MRI was performed 6–12 hours after the first stroke symptoms and infarct volumes were measured by two independent observers. Baseline National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score at discharge and period of hospitalization were calculated. Results: When patients using DOACs due to NVAF and patients with NDAF were compared, the volumes of patients using DOACs (median 7.8 vs 23.1 cm 3 ; P ≤ 0.01) were statistically significantly smaller. However, there was no difference in volume between ASA users (median 16.9 cm 3 ; P = 0.16) and patients with NDAF. The DOACs group was significantly different compared to the NDAF group in terms of NIHSS scores (median 4.4 vs 8.3; P ≤ 0.01) and mRS scores at discharge (median 1.7 vs 2.7; P ≤ 0.01), and period of hospitalization (median 6.4 vs 10.4 days; P ≤ 0.01). Conclusion: We observe, while using DOACs, the infarct volumes of patients who experience stroke are smaller than those with NDAF and using ASA, as well as mRS scores at discharge are low and length of hospital stay is short.

Characteristics and Mechanism of Acute Ischemic Stroke in NAVF Patients With Prior Oral Anticoagulant Therapy

“…Clinical evidence has shown that DOACs have a better safety profile and pharmacokinetics than warfarin in patients with NVAF 5–7 . Moreover, studies have shown that patients taking DOACs have reduced infarct volume and mRS scores compared with those taking other medications 15 . Therefore, we also evaluated whether prior anticoagulant therapy with DOACs was associated with better outcomes than warfarin therapy.…”

“…The initial NIHSS score was 8 (3,15) in the prior nonanticoagulant group, 7 (2,15) in the prior insufficient anticoagulant group, and 4 (1, 7.5) in the prior adequate anticoagulant group. Similar changes in the NIHSS score and the proportion of patients with mRS ≤ 2 at discharge were observed in the 3 groups.…”

“…Deguchi et al 14 reported that elderly patients with NVAF who received oral anticoagulation therapy had milder symptoms and better disease prognosis at the onset of cerebral infarction than those who did not. More interestingly, studies have shown that patients taking DOACs have reduced infarct volume and modified Rankin Scale (mRS) scores compared with patients taking other medications 15 . In a retrospective observational study, Rodriguez-Pardo et al 16 found that DOACs therapy was associated with reduced mortality at 3 months compared with adequate VKA anticoagulant therapy in patients with cardiogenic embolic stroke.…”

“…More interestingly, studies have shown that patients taking DOACs have reduced infarct volume and modified Rankin Scale (mRS) scores compared with patients taking other medications. 15 In a retrospective observational study, Rodriguez-Pardo et al 16 found that DOACs therapy was associated with reduced mortality at 3 months compared with adequate VKA anticoagulant therapy in patients with cardiogenic embolic stroke.…”

Admission Severity of Atrial-Fibrillation-Related Acute Ischemic Stroke in Patients under Anticoagulation Treatment: A Systematic Review and Meta-Analysis

“…Clot formation inhibition depends on the international normalized ratio (INR) for VKA and on plasma concentration for DOAC [ 31 ]. It is known that patients on VKA [ 32 ] or DOAC [ 33 ] therapy present with smaller infarct volumes on diffusion-weighted magnetic resonance imaging. There is some evidence showing an increased susceptibility to fibrinolysis in the presence of VKA or DOAC [ 31 , 32 ].…”