Insufficient Warfarin Therapy Is Associated With Higher Severity of Stroke Than No Anticoagulation in Patients With Atrial Fibrillation and Acute Anterior-Circulation Stroke

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

doi:10.1253/circj.cj-17-1110

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…However, the relationship between DOAC therapy and small infarct volume or no proximal artery occlusion seems to be theoretically plausible, because DOAC treatment offers pharmacokinetically consistent and adequate anticoagulation 13, 14, 15, 16. Sufficient anticoagulant treatment was known to have an important role in stroke severity or proximal artery occlusion for VKA‐treated AF patients,23 and indeed sufficient VKA therapy was also associated with smaller infarct volume or decreased risk of more proximal occlusion in the present study. Small and vulnerable thrombi are expected to be formed under consistent or sufficient anticoagulation.…”

Section: Discussionmentioning

confidence: 49%

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

Sakamoto

Okubo

Sekine

et al. 2018

JAHA

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BackgroundThe aims of the present study were to investigate the relationships between prior direct oral anticoagulant (DOAC) therapy and infarct volume and the site of arterial occlusion in patients with acute ischemic stroke and non‐valvular atrial fibrillation.Methods and ResultsFrom March 2011 through November 2016, consecutive patients with acute ischemic stroke in the middle cerebral artery territory and non‐valvular atrial fibrillation were recruited. The infarct volume was assessed semi‐automatically using initial diffusion‐weighted imaging, and the arterial occlusion site was evaluated on magnetic resonance angiography. The effect of prior DOAC treatment on the site of arterial occlusion was assessed by multivariate ordinal logistic regression analysis. A total of 330 patients (149 women; median age 79 [quartiles 71–86] years; median National Institutes of Health Stroke Scale score 11 [4–21]) were enrolled. Of these, 239 were on no anticoagulant, 40 were undertreated with a vitamin K antagonist (VKA), 22 were sufficiently treated with VKA (PT‐INR ≥1.6), and 29 were on a DOAC before the acute ischemic stroke. The infarct volume on admission differed among the groups (median 14.5 [2.0–59.8] cm3 in patients with no anticoagulation, 24.8 [2.1–63.0] in undertreated VKA, 1.3 [0.3–13.5] in sufficient VKA, and 2.3 [0.5–21.0] in DOAC, P=0.001). Multivariate analysis showed that prior DOAC treatment was independently and negatively associated with more proximal artery occlusion (odds ratio [OR] 0.34, P=0.015), compared with no anticoagulant.Conclusions DOAC treatment before the event was associated with smaller infarct volume and decreased risk of greater proximal artery occlusion in acute ischemic stroke patients with non‐valvular atrial fibrillation, compared with no anticoagulation.

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Section: Discussionmentioning

confidence: 49%

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

Sakamoto

Okubo

Sekine

et al. 2018

JAHA

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“…In contrast, subtherapeutic anticoagulation with VKA was associated with poor medication adherence. A PT-INR in the subtherapeutic range in patients receiving VKAs may lead to a transient hypercoagulable state due to the difference in plasma half-life between procoagulation factors II and X and anticoagulant proteins C and S [25,26]. Therefore, it is pharmacokinetically possible that, compared to the no anticoagulation group, the subtherapeutic group had similarly sized or larger thrombi, which may have resulted in an increased infarct volume [27].…”

Section: Discussionmentioning

confidence: 99%

Effects of sufficient anticoagulation on ischemic stroke outcomes in patients with nonvalvular atrial fibrillation

Kim,

Park,

Kim

et al. 2023

J Neurocrit Care

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Background: Optimal anticoagulation therapy reduces the risk of ischemic stroke in patients with nonvalvular atrial fibrillation (AF). Therefore, we aimed to evaluate the effects of prior anticoagulation therapy with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) on ischemic stroke outcomes in patients with nonvalvular AF.Methods: We enrolled 487 patients with ischemic stroke and nonvalvular AF between January 2013 and August 2020. The infarct volume was semi-automatically evaluated using diffusion-weighted magnetic resonance imaging. Patients were categorized into no anticoagulation, undertreated anticoagulation, and sufficient anticoagulation (with VKA or DOAC) groups based on their pre-admission anticoagulant use, and the clinical characteristics were compared between the groups.Results: Among the included patients, 374 (76.8%), 50 (10.3%), 10 (2.1%), and 53 (10.9%) patients received no anticoagulants, were undertreated with a VKA, were sufficiently treated with a VKA, and received DOACs, respectively, before stroke. Multivariate analysis revealed that optimal anticoagulation was independently associated with a low risk of severe stroke (odds ratio, 0.553; 95% confidence interval, 0.308–0.992; P=0.047). Additionally, the DOAC group had a significantly smaller mean infarct volume than the other groups (45.8±73.2, 45.0±69.1, 30.9±24.7, and 12.6±24.9 mL in the no anticoagulation, insufficient VKA, sufficient VKA, and DOAC groups, respectively; P=0.011).Conclusion: Sufficient pre-stroke anticoagulation is associated with mild stroke severity and good outcomes at 3 months post-stroke. Additionally, pre-stroke DOAC treatment is associated with smaller infarct volume in patients with ischemic stroke and nonvalvular AF.

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“…Позже были получены доказательства, что позитивное влияние АВК наблюдается только у лиц, стабильно удерживающих МНО в целевом диапазоне. Сходный результат был достигнут и при лечении ПОАК [14,20]. В исследовании S. Hellwig и соавт.…”

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“…Отмеченный нами некоторый благоприятный эффект ААГ в отношении уменьшения тяжести инсульта также согласуется с ранее полученными данными [20] и должен стать аргументом для более строгого соблюдения рекомендаций по ведению пациентов с коронарной патологией.…”

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The quality of prior antithrombotic therapy and the severity of ischemic stroke in atrial fibrillation

Гераскина

Alieva

Fonyakin

et al. 2020

RJTAO

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The severity of neurological disorders in ischemic stroke (IS) in the presence of atrial fibrillation (AF) is known to be higher than that in patients with sinus rhythm. The impact of preventive antithrombotic therapy (ATT) on the clinical manifestations and outcomes of stroke remains a matter of debate.Objective: to analyze the quality of preventive ATT and to clarify its relationship to the severity of IS in AF.Patients and methods. The data from the registry of patients (n = 200; 96 (48%) men) (mean age, 71±9 years) with IS and AF were analyzed. Neurological deficit at admission was graded using the National Institutes of Health Stroke Scale (NIHSS). The presence and nature of prestroke antithrombotic therapy were studied.Results and discussion. Prestroke ATT was performed in 80 (40%) patients, of whom 36 (18%) took antiplatelet agents (APAs). Oral anticoagulants (OACs) were given to 44 patients. The international normalized ratio (INR) in the use of vitamin K antagonists (VKAs) averaged 1.26 [1.11; 1.64]. Neurological deficit was most obvious in the patients who had not previously received ATT (a NIHSS score of 8 [5; 12]). In comparison with them, the regular use of ATT, including APAs and OACs, was associated with the greater likelihood of less severe neurological deficit (a NIHSS of <8): odds ratio (OR), 2.121; 95% confidence interval (CI), 1.178–3.820. The greatest decrease in stroke severity was related to direct (OACs) (DOACs): OR, 2.727 (95% CI, 1.049–7.089), while there was no positive effect of VKAs (OR, 1.534; 95% CI, 0.538–4.377), which was associated with failure to achieve the INR target. Improvement was also related to the prescription of APAs (OR, 2.111; 95% CI, 0.981–4.539).Conclusion. Preventive ATT for a significant proportion of AF patients does not meet the current recommendations. At the same time, ATT, especially that with DOACs, is associated with the lesser severity of IS.

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Insufficient Warfarin Therapy Is Associated With Higher Severity of Stroke Than No Anticoagulation in Patients With Atrial Fibrillation and Acute Anterior-Circulation Stroke

Cited by 9 publications

References 24 publications

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

Prior Direct Oral Anticoagulant Therapy is Related to Small Infarct Volume and No Major Artery Occlusion in Patients With Stroke and Non‐Valvular Atrial Fibrillation

Effects of sufficient anticoagulation on ischemic stroke outcomes in patients with nonvalvular atrial fibrillation

The quality of prior antithrombotic therapy and the severity of ischemic stroke in atrial fibrillation

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