Key result
Prior NOAC use linked to ~154% higher successful reperfusion after EVT vs antiplatelets or no therapy.
Why the study?
The study assessed the influence of prior NOAC use compared with antiplatelet agents or no antithrombotic use on stroke outcomes after endovascular treatment in patients with high pre-stroke CHA2DS2-VASc scores.
Does prior NOAC use improve successful reperfusion and stroke outcomes in high-risk acute ischemic stroke patients with atrial fibrillation undergoing EVT compared to prior antiplatelet or no antithrombotic use?
Observational (n=418)
Yes
Does prior NOAC use improve successful reperfusion and stroke outcomes in high-risk acute ischemic stroke patients with atrial fibrillation undergoing EVT compared to prior antiplatelet or no antithrombotic use?
Odds Ratio: 2.54 (95% CI 1.34–4.83)
p-value: p=0.004
Prior NOAC use is associated with higher successful reperfusion rates and improved stroke outcomes without increasing symptomatic hemorrhagic transformation in high-risk acute ischemic stroke patients undergoing endovascular treatment.
May support NOAC continuation before EVT in AF stroke; hypothesis-generating, requires RCTs before practice change.
BACKGROUND: We assessed the influence of prior non-vitamin K antagonist (NOAC) use on stroke outcomes after endovascular treatment (EVT) in patients at a high risk of stroke based on their pre-stroke CHA2DS2-VASc score, and compared them with those who did not use any antithrombotic (NAU) or antiplatelet (APT) agents. METHODS: Data were collected from a multicenter database comprising consecutive acute ischemic stroke patients who underwent EVT during a span of 103 months. We evaluated pre-stroke CHA2DS2-VASc scores in enrolled patients and measured instances of successful reperfusion and symptomatic hemorrhagic transformation (SHT) following EVT as the main outcome measures. RESULTS: Among 12 807 patients with acute ischemic stroke, 3765 (29.4%) had a history of atrial fibrillation. Of these, 418 patients with CHA2DS2-VASc scores ≥2 received EVT alone. The prior NOAC group showed higher successful reperfusion rates compared with the prior NAU and APT groups (p=0.04). Multivariate analysis revealed that prior NOAC use increased the likelihood of successful reperfusion after EVT (OR [95% CI] 2.54 [1.34 to 4.83], p=0.004) and improved stroke outcomes, while the prior APT group did not. Furthermore, the prior NOAC use group was not associated with SHT after EVT. Propensity score matching confirmed these findings. CONCLUSION: Prior use of NOAC is associated with improved outcomes in high-risk stroke patients (pre-stroke CHA2DS2-VASc score ≥2) undergoing EVT.
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Kim et al. (2023) conducted an observational in Acute ischemic stroke (n=418). Prior non-vitamin K antagonist oral anticoagulant (NOAC) use vs. No antithrombotic or antiplatelet agents was evaluated on Successful reperfusion following endovascular treatment (OR 2.54, 95% CI 1.34 to 4.83, p=0.004). Prior NOAC use increased successful reperfusion after endovascular treatment in high-risk stroke patients compared to no antithrombotics or antiplatelets (OR 2.54; 95% CI 1.34-4.83; p=0.004).
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