Key result
Prolongation of coagulation assay markers upon admission in patients with cardioembolic stroke on DOACs was associated with a significantly lower prevalence of large vessel occlusion (27% vs. 53%).
Why the study?
Although acute cerebral infarction severity varies in patients receiving DOACs, no practical method to predict severity has been established.
Does prolongation of standard coagulation markers upon admission predict reduced stroke severity and lower prevalence of large vessel occlusion in patients with cardioembolic cerebral infarction during DOAC use?
Observational (n=71)
No
Does prolongation of standard coagulation markers upon admission predict reduced stroke severity and lower prevalence of large vessel occlusion in patients with cardioembolic cerebral infarction during DOAC use?
In patients experiencing a cardioembolic stroke while on DOACs, prolongation of standard coagulation markers (PT or APTT) upon admission is associated with milder stroke severity and a lower prevalence of large vessel occlusion.
Answers are grounded in this paper and cite their sources.
May indicate milder cardioembolic strokes on DOACs; leaves open prognostic value pending prospective validation.
Although the severity of acute cerebral infarction varies in patients receiving direct oral anticoagulants (DOACs), no practical method to predict the severity has been established. We analyzed retrospectively the relationship between cardioembolic cerebral infarction severity and coagulation indicators in patients treated with DOACs. We assessed the anticoagulation effect of DOACs using the activated partial thromboplastin time (APTT), prothrombin time (PT), and prothrombin time international standardized ratio (PT-INR) in 71 patients with cardioembolic cerebral infarction admitted to our hospital between January 2015 and December 2019. The participants were divided into a prolongation group (prolonged APTT for oral thrombin inhibitors or prolonged PT for oral factor Xa inhibitors, n =37) and a normal group (no prolongation of coagulation markers, n =34). Of the 71 patients, 21 (30%) and 50 (70%) were using oral thrombin and oral factor Xa inhibitors, respectively. PT, PT-INR, and APTT were significantly higher in the prolongation group (PT: 17.4 ± 5.1 vs. 12.8 ± 1.4 s, P < 0.001; PT-INR: 1.5 ± 0.5 vs. 1.1 ± 0.1, P < 0.001; APTT: 44.8 ± 26.4 vs. 30.4 ± 4.1 s, P = 0.003). The median National Institutes of Health Stroke Scale (NIHSS) score on admission and the prevalence of large vessel occlusion were significantly lower in the prolongation group (NIHSS: 2.0 vs. 9.5, P = 0.007; large vessel occlusion: 27% vs. 53%, P = 0.031). The prevalence of large vessel occlusion was low and stroke severity was mild in patients undergoing DOAC therapy with prolongation of coagulation assay markers upon onset of cardioembolic cerebral infarction.
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A 2021 study conducted an observational in Cardioembolic cerebral infarction during DOAC use (n=71). Prolongation of coagulation assay markers vs. Normal coagulation assay markers was evaluated on Large vessel occlusion (p=0.031). Prolongation of coagulation assay markers upon admission in patients with cardioembolic stroke on DOACs was associated with a significantly lower prevalence of large vessel occlusion (27% vs. 53%).
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