In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 4 ( 2022-4-6), p. e0264760-
Abstract:
The optimal timing of initiating oral anticoagulants after reperfusion therapy for ischemic stroke is unknown. Factors related to early initiation of rivaroxaban and differences in clinical outcomes of stroke patients with nonvalvular atrial fibrillation (NVAF) who underwent reperfusion therapy was investigated. Methods From data of 1,333 NVAF patients with ischemic stroke or transient ischemic attack (TIA) in a prospective multicenter study, patients who started rivaroxaban after intravenous thrombolysis and/or mechanical thrombectomy were included. The clinical outcomes included the composite of ischemic events (recurrent ischemic stroke, TIA, or systemic embolism) and major bleeding at 3 months. Results Among the 424 patients, the median time from index stroke to starting rivaroxaban was 3.2 days. On multivariable logistic regression analysis, infarct size (odds ratio [OR], 0.99; 95%CI, 0.99–1.00) was inversely and successful reperfusion (OR, 2.13; 95%CI, 1.24–3.72) was positively associated with initiation of rivaroxaban within 72 hours. 205 patients were assigned to the early group ( 〈 72 hours) and 219 patients (≥ 72 hours) to the late group. Multivariable Cox regression models showed comparable hazard ratios between the two groups at 3 months for ischemic events (hazard ratio [HR], 0.18; 95%CI, 0.03–1.32) and major bleeding (HR, 1.80; 95%CI, 0.24–13.54). Conclusions Infarct size and results of reperfusion therapy were associated with the timing of starting rivaroxaban. There were no significant differences in the rates of ischemic events and major bleeding between patients after reperfusion therapy who started rivaroxaban 〈 72 hours and ≥ 72 hours after the index stroke. Clinical trial registration Unique identifier: NCT02129920 ; URL: https://www.clinicaltrials.gov .
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0264760
DOI:
10.1371/journal.pone.0264760.g001
DOI:
10.1371/journal.pone.0264760.g002
DOI:
10.1371/journal.pone.0264760.t001
DOI:
10.1371/journal.pone.0264760.t002
DOI:
10.1371/journal.pone.0264760.t003
DOI:
10.1371/journal.pone.0264760.s001
DOI:
10.1371/journal.pone.0264760.s002
DOI:
10.1371/journal.pone.0264760.s003
DOI:
10.1371/journal.pone.0264760.s004
DOI:
10.1371/journal.pone.0264760.s005
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
Bookmarklink
