Abstract 16508: Severity and Functional Outcome of Patients With Cardioembolic Stroke Occurring During Novel Oral Anticoagulant Treatment
Introduction: Severity and functional outcome of patients with cardioembolic stroke (CE) that occurs during novel oral anticoagulant (NOAC) treatment remain uncertain. This study aimed to evaluate these features in comparison with CE patients during warfarin treatment and no anticoagulants.
Methods and Results: The consecutive 308 CE patients admitted to our stroke center within 48 hours after the onset from April 2011 through October 2013 and with modified Rankin Scale (mRS) 0 or 1 before the onset, were retrospectively studied.
Of all, 228 patients (74%) were treated with no anticoagulants (Non-AC), 67 with warfarin (22%), and 13 with NOAC (4%)(9 dabigatran and 4 rivaroxaban). The patients with warfarin treatment were further divided into the two groups by the PT-INR value at admission based on the Japanese Guideline: low range (INR<1.6, n=54, WF-Lo) and therapeutic range groups (INR≤1.6, n=13, WF-Tp). There was no difference in mean age among the four groups: 78±9 years in Non-AC, 77±9 in WF-Lo, 74±10 in WF-Tp, and 72±9 in NOAC (p=0.09). CHADS2 score before the onset did not differ among the four groups (2.9±1.4, 3.4±1.4, 3.2±0.9, and 2.8±1.4, respectively, p=0.17). Severity of stroke at admission was assessed by the National Institutes of Health Stroke Scale (NIHSS) score. It was 6±7 in WF-Tp and 7±8 in NOAC (p=NS), while it was 12±9 in Non-AC and 13±9 in WF-Lo (p=NS)(p=0.02 between WF-Tp and Non-AC, and p=0.04 between NOAC and Non-AC by the Steel-Dwass test). Functional outcome at discharge, assessed by mRS, was favorable in patients with WF-Tp and NOAC compared with Non-AC and WF-Lo groups: It was 1.7±2.0 in WF-Tp and 1.9±1.8 in NOAC versus 2.8±1.8 in Non-AC and 2.9±2.0 in WF-Lo (p=0.027 by the Kruskal-Wallis test). Of note, adherence in 3 NOAC patients was poor and other 3 NOAC patients had a temporary cessation of the therapy due to colon polypectomy and worsened renal function prior to the stroke onset.
Conclusions: Severity of stroke and functional outcome of CE patients treated with warfarin in the therapeutic range or with NOAC are similar to each other, and are more favorable than those with no anticoagulants and with warfarin below the therapeutic range. Poor adherence and temporary cessation of NOAC are likely important for the occurrence of NOAC-associated CE.
Author Disclosures: H. Tomita: None. J. Hagii: Research Grant; Significant; Bayer Healthcare. Speakers Bureau; Modest; Bayer Healthcare, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer. N. Metoki: Speakers Bureau; Modest; Boehringer Ingelheim, Bayer Healthcare, Bristol-Myers Squibb, Pfizer. S. Saito: None. H. Shiroto: None. T. Osanai: None. M. Yasujima: Speakers Bureau; Modest; Bristol-Myers Squibb, Pfizer. K. Okumura: Research Grant; Significant; Boehringer Ingelheim, Bayer Healthcare, Daiichi-Sankyo. Speakers Bureau; Modest; Boehringer Ingelheim, Bayer Healthcare, Bristol-Myers Squibb, Pfizer, Eisai.
- © 2014 by American Heart Association, Inc.