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Non-vitamin K oral anticoagulants as first-line regimen for acute ischemic stroke with non-valvular atrial fibrillation

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Author(s)
Chan Wook ParkHyo Suk NamJi Hoe HeoHyung Jong ParkJin Kyo ChoiHye Sun LeeHan Kyu NaYoung Dae Kim
Keimyung Author(s)
Park, Hyung Jong
Department
Dept. of Neurology (신경과학)
Journal Title
Journal of Stroke and Cerebrovascular Diseases
Issued Date
2020
Volume
29
Issue
9
Keyword
AnticoagulantAtrial fibrillationCerebral infarctionOutcome
Abstract
Purpose:
There are various patterns in determining the choice of the first-line antithrombotic agent for acute stroke with non-valvular atrial fibrillation. We investigated the efficacy and safety of non-vitamin K oral anticoagulants as first-line antithrombotics for patients with acute stroke and non-valvular atrial fibrillation.

Materials and methods:
Patients with non-valvular atrial fibrillation and ischemic stroke or transient ischemic attack within 24 h from stroke onset were included. On the basis of the first regimen used and the regimen within 7 days after admission, the study population was divided into three groups: 1) antiplatelet switched to warfarin (A-W), 2) antiplatelet switched to NOAC (A-N), and 3) NOAC only (N only). We compared the occurrence of early neurologic deterioration, symptomatic intracranial hemorrhage, systemic bleeding, and poor functional outcome at 90 days.

Results:
Of 314 included patients, 164, 53, and 97 were classified into the A-W, A-N, and N only groups, respectively. Early neurologic deterioration was most frequently observed in the A-W group (9.1%), followed by the A-N (5.7%) and N only (1.0%) groups (p = 0.017). Multivariable analysis adjusting for potential confounders demonstrated that the N only group was independently associated with a lower rate of early neurologic deterioration (odds ratio [OR] 0.104, 95% CI 0.013-0.831) or poor functional outcome at 90 days (OR 0.450, 95% CI 0.215-0.940) than the A-W group. However, the rate of symptomatic intracranial hemorrhage or any systemic bleeding event did not differ among the groups.

Conclusion:
Using non-vitamin K oral anticoagulants as the first-line regimen for acute ischemic stroke may help prevent early neurologic deterioration without increasing the bleeding risk.
Keimyung Author(s)(Kor)
최진교
Publisher
School of Medicine (의과대학)
Citation
Chan Wook Park et al. (2020). Non-vitamin K oral anticoagulants as first-line regimen for acute ischemic stroke with non-valvular atrial fibrillation. Journal of Stroke and Cerebrovascular Diseases, 29(9), 105025. doi: 10.1016/j.jstrokecerebrovasdis.2020.105025
Type
Article
ISSN
1532-8511
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1052305720304432
DOI
10.1016/j.jstrokecerebrovasdis.2020.105025
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43201
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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