Preceding direct oral anticoagulant administration reduces the severity of stroke in patients with atrial fibrillation – K-PLUS registry

Nakajima, Makoto; Inatomi, Yuichiro; Ueda, Akihiko; Ito, Yasuyuki; Kouzaki, Yanosuke; Takita, Tomohiro; Wada, Keita; Yonehara, Toshiro; Terasaki, Tadashi; Hashimoto, Yoichiro; Ando, Yukio

doi:10.1016/j.jocn.2021.04.027

Cited by 3 publications

(8 citation statements)

References 29 publications

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“…Furthermore, preceding DOAC administration was an independent factor for a good outcome at 3 months after stroke, irrespective of the dose. These results are in line with reports showing that patients who were taking anticoagulant drugs, especially DOACs, preceding a stroke had lower NIHSS scores on admission than patients taking no anticoagulant drugs [5-7, 9, 10]. However, we divided initial stroke severity into 3 ordinal categories, as opposed to past studies using binary cutoff NIHSS scores.…”

Section: Discussionsupporting

confidence: 79%

“…The administration rate of anticoagulant agents in our study was roughly similar to those of past reports. The administration rate of DOACs in our study, which was 15.4%, was lower than that reported in the USA (29%) [9], but similar to that reported in Japan (12.5%) [7]. 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.…”

Section: Discussionsupporting

confidence: 68%

“…Our study showed the effect of DOACs at reducing stroke severity even though we included cardioembolic stroke as a variable in multivariate analysis. This ability of DOACs to reduce initial stroke severity might also be supported by studies showing that patients taking DOACs tend to have a smaller infarct volume and a decreased risk of more proximal artery occlusions [7, 11], and that patients taking DOACs have lower levels of D-dimer levels, which are related to infarct volume [24].…”

Section: Discussionmentioning

confidence: 95%

“…The ordinal analysis of our study showed more clearly the effects of DOACs on initial stroke severity. One possible explanation for these results is that DOACs might prevent severe cardioembolic stroke, and in fact, cardioembolic stroke is less frequent in patients with DOACs [4, 7]. A study that restricted their patients to those with cardioembolic stroke reported that DOACs decreased stroke severity [5].…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that in patients with atrial fibrillation (AF), anticoagulant therapy, including vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs), is effective at reducing initial stroke severity [1][2][3][4] and yield-ing better outcomes [2,[5][6][7] in addition to preventing stroke and systemic embolism [8]. Most studies examining the effects of VKA on initial stroke severity and outcome use the degree of prothrombin time-international normalized ratio (PT-INR) control as a reference point [1][2][3][4][5][6][9][10][11]; however, except for one study [12], DOAC studies did not reference dose appropriateness.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Oral Anticoagulant Therapy and Risk of Admission to Long-Term Care in patients With Atrial Fibrillation: A Nationwide Cohort Study

Teppo

Airaksinen

Halminen

et al. 2023

Journal of the American Medical Directors Association

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Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study

Lyth

Svennberg

Bernfort

et al. 2022

European Heart Journal

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Aims Previous studies on the cost-effectiveness of screening for atrial fibrillation (AF) are based on assumptions of long-term clinical effects. The STROKESTOP study, which randomised 27 975 persons aged 75/76 years into a screening invitation group and a control group, has a median follow-up time of 6.9 years. The aim of this study was to estimate the cost-effectiveness of population-based screening for AF using clinical outcomes. Methods and results The analysis is based on a Markov cohort model. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death was taken from the literature. Uncertainty in the model was considered in a probabilistic sensitivity analysis. Per 1000 individuals invited to the screening, there were 77 gained life years and 65 gained quality-adjusted life years. The incremental cost was €1.77 million lower in the screening invitation group. Gained quality-adjusted life years to a lower cost means that the screening strategy was dominant. The result from 10 000 Monte Carlo simulations showed that the AF screening strategy was cost-effective in 99.2% and cost-saving in 92.7% of the simulations. In the base-case scenario, screening of 1000 individuals resulted in 10.6 [95% confidence interval (CI): −22.5 to 1.4] fewer strokes (8.4 ischaemic and 2.2 haemorrhagic strokes), 1.0 (95% CI: −1.9 to 4.1) more cases of systemic embolism, and 2.9 (95% CI: −18.2 to 13.1) fewer bleedings associated with hospitalization. Conclusion Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation.

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Preceding direct oral anticoagulant administration reduces the severity of stroke in patients with atrial fibrillation – K-PLUS registry

Cited by 3 publications

References 29 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

Oral Anticoagulant Therapy and Risk of Admission to Long-Term Care in patients With Atrial Fibrillation: A Nationwide Cohort Study

Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study

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