March 31, 2026Polskie Archiwum Medycyny Wewnętrznej0 citationsOpen Access

Stroke severity and outcomes in patients with high therapeutic anticoagulant activity: a retrospective observational cohort matched-control study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (n=152). Intervention: Direct oral anticoagulants (DOACs) vs. No DOAC prior to admission. Primary outcome: Favorable functional outcome (mRS 0-2) at 90 days (RD 0.08, 95% CI -0.16 to 0.32).

BKBartosz KaraszewskiUniversity of Gdańsk BJBartosz JabłońskiUniversity Clinical Centre AWAdam WyszomirskiGdańsk Medical University

Key Result

High plasma DOAC activity (>50 ng/ml) on admission for acute ischemic stroke did not significantly improve favorable functional outcomes at 90 days compared to no DOAC use.

Study Design

Type

Cohort (n=152)

Multicenter

Structured PICO

Does high therapeutic anticoagulant activity from DOACs prior to stroke improve functional outcomes at 3 months in patients with acute ischemic stroke?

Population

152 patients diagnosed with acute ischemic stroke (AIS), including a DOAC group (n=60) and a matched non-DOAC group (n=92). Median age 78.5-81 years, 52.2-56.7% female. Key inclusion: AIS patients hospitalized at the Department of Adult Neurology in Gdańsk. Exclusions: specific AIS treatments (mechanical thrombectomy or intravenous thrombolysis), VKAs, therapeutic-dose heparin, unfractionated heparin, or DOAC treatment without documented levels or in non-therapeutic doses.

Intervention

Direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban) prior to stroke onset, with high therapeutic anticoagulant activity on admission (plasma DOAC concentration >50 ng/ml).

Comparator

No DOACs prior to admission (or DOAC activity null), matched for age and sex.

Outcome

Functional outcome reflected in a 3-month modified Rankin Scale (mRS) score (0-2 points indicating good outcome), obtained through telephone interviews with patients or caregivers.patient reported

High therapeutic DOAC activity on admission for acute ischemic stroke is associated with reduced neurological severity at discharge, though it did not significantly improve 90-day functional outcomes in this small cohort.

Main Result

Effect estimate: RD 0.08 (95% CI -0.16 to 0.32)

Absolute Event Rate: 31% vs 22.6%

Limitations

Lack of detailed information regarding the timing of the last DOAC intake
Did not report events of intracranial bleeding
Retrospective design with potential unmeasured confounding variables
Strict inclusion criteria and matching may restrict generalizability
Small sample size might have diminished statistical power

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Cite This Study

Karaszewski et al. (Mon,) conducted a cohort in Acute ischemic stroke (n=152). Direct oral anticoagulants (DOACs) vs. No DOAC prior to admission was evaluated on Favorable functional outcome (mRS 0-2) at 90 days (RD 0.08, 95% CI -0.16 to 0.32). High plasma DOAC activity (>50 ng/ml) on admission for acute ischemic stroke did not significantly improve favorable functional outcomes at 90 days compared to no DOAC use.

synapsesocial.com/papers/6a025c99edf6f481385947ca https://doi.org/https://doi.org/10.20452/pamw.17247