In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
Kurzfassung:
Introduction: Discontinuation of antithrombotics can be associated with an increased risk of cardiovascular events and poor outcomes. Abrupt warfarin withdrawal may also induce a rebound or a paradoxical prothrombotic state, subsequently leading to an increased incident risk of stroke for up to 3 months. Hypothesis: Considering the potent anticoagulant effect of non-vitamin K oral anticoagulants (NOACs) on the suppression of thrombogenesis, NOAC withdrawal may be associated with profound hypercoagulable state, leading to severe stroke and poor outcomes in patients with non-valvular atrial fibrillation (NVAF) related stroke. The aim of this study was to compare the initial stroke severity and functional outcome associated with NOAC withdrawal to those associated with other prior medication statuses including warfarin withdrawal in patients with NVAF. Methods: A total of 719 patients with ischemic stroke or transient ischemic attack and NVAF who were admitted at five regional hospitals between January 2013 and December 2016 were included. Prior medication status was categorized into seven groups such as no antithrombotics, antiplatelet-only, warfarin with a subtherapeutic intensity, warfarin with a therapeutic intensity, NOAC, warfarin withdrawal, and NOAC withdrawal. We compared initial National Institute of Health Stroke Scale (NIHSS) scores between groups. Results: The mean age was 73.9 ±10.2 years, and 397 (55.2%) patients were men. Median CHA 2 DS 2 -VASc score was 4 (interquartile range [IQR] 3-5). Among 719 patients, the NOAC withdrawal group had the highest median NIHSS scores at stroke onset (16, interquartile range, IQR [4-20] ), followed by the warfarin withdrawal group (11, IQR [3-17]), the no antithrombotic group (5, IQR [2-16] ), and the warfarin with subtherapeutic intensity group (5, IQR [2-13]). Multivariable analysis demonstrated that NOAC withdrawal was independently associated with higher NIHSS scores at stroke onset (B 4.645, 95% CI 0.384-8.906, P=0.033). Conclusions: Stroke occurred after discontinuing oral anticoagulants, particularly NOAC, was independently associated with severe stroke severity.
Materialart:
Online-Ressource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.50.suppl_1.TP226
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2019
ZDB Id:
1467823-8
