Thromb Haemost 2018; 118(12): 2145-2151
DOI: 10.1055/s-0038-1675602
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose

Yo Han Jung
1  Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
,
Hye-Yeon Choi
2  Department of Neurology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
,
Kyung-Yul Lee
3  Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
,
Kyeongyeol Cheon
3  Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
,
Sang Won Han
4  Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
,
Joong Hyun Park
4  Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
,
Han-Jin Cho
5  Department of Neurology, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
,
Hyung Jong Park
6  Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Hyo Suk Nam
6  Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Ji Hoe Heo
6  Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
,
Hye Sun Lee
7  Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
,
Young Dae Kim
6  Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
› Author Affiliations
Funding This work was supported by a grant of the Korea Heath Technology R&D Project through the Korea Health Industry Development (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI08C2149) and a faculty research grant from the Yonsei University College of Medicine (6–2017–0128).
Further Information

Publication History

06 July 2018

22 September 2018

Publication Date:
19 November 2018 (eFirst)

Abstract

Background The stroke severity or functional outcomes could differ because the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) could be different according to the dose. We investigated whether there was any difference in the stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) by their prior medication status, including standard-dosed versus under-dosed NOACs.

Materials and Methods We enrolled 858 patients with acute ischaemic stroke with chronic NVAF admitted at six hospitals in Korea. We categorized their prior medication status as follows: (1) no anti-thrombotics (n = 219), (2) only anti-platelet (n = 347), (3) warfarin with a sub-therapeutic intensity (n = 185), (4) warfarin with a therapeutic intensity (n = 37), (5) under-dosed NOAC (n = 27) and (6) standard-dosed NOAC (n = 43). We compared the initial stroke severity between groups.

Results Among the 858 patients, the patients on standard-dosed NOACs had the lowest initial National Institute of Health Stroke Scale (NIHSS) score, followed by those on warfarin with a therapeutic intensity and those on only anti-platelet (p < 0.05). Multivariate analysis demonstrated that the NIHSS score was significantly low in the patients on warfarin with a therapeutic intensity (B, –5.602; 95% confidence interval [CI], –8.636 to –2.568; p < 0.001) or those on standard-dosed NOACs (B, –3.588; 95% CI, –6.405 to –0.771; p = 0.013), while there was no difference in the NIHSS score between the patients not taking any anti-thrombotics and those on warfarin with a sub-therapeutic intensity or under-dosed NOACs.

Conclusion Use of warfarin with a therapeutic intensity or standard-dosed NOACs was associated with a relatively mild stroke in the patients with NVAF.

Supplementary Material