Key result
Prior anticoagulation in NVAF stroke is linked to more discharge mRS ≤2 vs no anticoagulation.
Why the study?
The study was conducted to analyze the characteristics and mechanisms of acute ischemic stroke in patients with nonvalvular atrial fibrillation who received prior anticoagulant therapy.
Does prior adequate anticoagulant therapy reduce stroke severity and improve outcomes in patients with NVAF who develop acute ischemic stroke?
Cohort (n=749)
Does prior adequate anticoagulant therapy reduce stroke severity and improve outcomes in patients with NVAF who develop acute ischemic stroke?
In patients with NVAF who suffer an acute ischemic stroke, prior adequate anticoagulation is associated with milder stroke severity and better functional outcomes at discharge.
Supports better discharge outcomes with prior anticoagulation in NVAF stroke; hypothesis-generating, requires RCTs to confirm.
OBJECTIVES: We aimed to analyze the characteristics and mechanisms of acute ischemic stroke (AIS) in patients with nonvalvular atrial fibrillation (NVAF) who received prior anticoagulant therapy. METHODS: We retrospectively analyzed the data of patients with NVAF and AIS between January 2016 and December 2021. Patients were divided into non-anticoagulant, adequate anticoagulant, and insufficient anticoagulant groups according to their prior anticoagulant status. Patients with prior anticoagulant therapy were further divided into warfarin and direct oral anticoagulant groups. RESULTS: A total of 749 patients (661 without anticoagulants, 33 with adequate anticoagulants, and 55 with insufficient anticoagulants) were included. Patients with adequate anticoagulant had a milder National Institute of Health Stroke Scale at presentation ( P =0.001) and discharge ( P =0.003), a higher proportion of Modified Rankin Scale (mRS) ≤2 at discharge ( P =0.011), and lower rates of massive infarction ( P =0.008) than patients without anticoagulant. Compared with the non-anticoagulant group, the proportion of intravenous thrombolysis was significantly lower in the adequate anticoagulant ( P <0.001) and insufficient anticoagulant ( P =0.009) groups. Patients in the adequate anticoagulant group had higher rates of responsible cerebral atherosclerotic stenosis ( P =0.001 and 0.006, respectively) and competing large artery atherosclerotic mechanisms ( P =0.006 and 0.009, respectively) than those in the other 2 groups. Compared with warfarin, direct oral anticoagulant was associated with higher rates of Modified Rankin Scale ≤2 at discharge ( P =0.003). CONCLUSIONS: Adequate anticoagulant therapy may be associated with milder stroke severity and better outcomes at discharge in patients with NVAF. Competing large artery atherosclerotic mechanisms may be associated with anticoagulant failure in patients with NAVF with prior adequate anticoagulant therapy.
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Xue et al. (2023) conducted a cohort in Acute ischemic stroke in patients with nonvalvular atrial fibrillation (n=749). Adequate prior anticoagulant therapy vs. No anticoagulant therapy was evaluated on Modified Rankin Scale (mRS) ≤2 at discharge (p=0.011). Adequate prior anticoagulant therapy in NVAF patients with acute ischemic stroke was associated with a higher proportion of mRS ≤2 at discharge compared to no anticoagulation (P=0.011).
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