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

Abstract

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.

MRI characteristics in acute ischemic stroke patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists

“…Sakamoto et al found DOAC therapy to be associated with smaller infarct sizes on MRI in a smaller study (40 non-therapeutic VKA, 22 confirmed therapeutic VKA and 29 DOAC, 239 controls) [9]. However, the authors compared non-therapeutic VKA and DOAC treatment with controls without laboratory assessment of DOAC activity or information on compliance.…”

“…Nevertheless, data on imaging characteristics of AIS in patients taking OAC, especially DOAC are sparse [7,8]. Few comparative small studies looked at size, volume and presence of a large vessel occlusion (LVO) [9,10] in patients taking DOAC versus VKA, with preliminary results in favor of DOAC. However, no laboratory assessment of OAC activity or information on compliance for DOAC was available.…”

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

“…Получены пилотные данные, свидетельствующие, что благоприятный клинический эффект может быть связан с формированием инфаркта мозга меньшего объема [21]. Так, выявлен статистически значимо больший объем инфаркта у больных, не получавших ранее ОАК (14,5 [2,0; 59,8] см 3 ), и в случае недостаточной гипокоагуляции на фоне АВК (24,8 [2,1; 63,0] см 3 ), тогда как при МНО ≥2 объем инфаркта составлял 1,3 [0,3; 13,5] см 3 , а у пациентов, ранее принимавших ПОАК, -2,3 [0,5; 21,0] см 3 .…”

“…Более того, Y. Sakamoto и соавт. [21] было показано, что нерациональный прием АВК может чаще сопровождаться окклюзией более крупных внутричерепных артерий не только по сравнению с больными, достигшими целевой гипокоагуляции, но и с пациентами, ранее не получавшими ОАК.…”

MRI Characteristics in Acute Ischemic Stroke Patients with Preceding Direct Oral Anticoagulant Therapy as compared to Vitamin K Antagonists

“…Nevertheless, data on imaging characteristics of AIS in patients taking OAC, especially DOAC are sparse (8,9). Few comparative small studies looked at size, volume and presence of a large vessel occlusion (LVO) (10,11) in patients taking DOAC versus VKA, with preliminary results in favor of DOAC. However, no laboratory assessment of OAC activity or information on compliance for DOAC was available.…”