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Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association v.27 no.1, 2018년, pp.76 - 82   SCIE
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Confidence in the Use of Direct Oral Anticoagulants in the Acute Phase of Nonvalvular Atrial Fibrillation–Related Ischemic Stroke Over the Years: A Real-World Single-Center Study

Moroni, Federico (Address correspondence to Luca Masotti, MD, Internal Medicine, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova 1, 50122 Florence, Italy. ) ; Masotti, Luca ; Vannucchi, Vieri ; Chiarelli, Raffaella ; Seravalle, Cristiana ; Pesci, Alessandra ; Pallini, Francesca ; Puliti, Silvia ; Cimolato, Barbara ; Fattorini, Lamberto ; Scerra, Cornelia ; Ristori, Francesca ; Imbalzano, Maria Letizia ; Spolveri, Stefano ; Landini, Giancarlo ; Grifoni, Elisa ; Paciaroni, Maurizio ;
  • 초록  

    Backgroud and Aim The use of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) is controversial. The aims of our study were to analyze physicians' confidence in prescribing DOACs in NVAF-related AIS, the characteristics of patients receiving DOACs, and their 90-day prognosis. Material and Methods Clinical records of consecutive patients admitted to our wards for NVAF-related AIS over the years 2014-2016 were reviewed. Results One hundred forty-seven patients, 72.7% females, mean age ± standard deviation 83.4 ± 8.8 years, were admitted to our ward for atrial fibrillation (AF)-related AIS (38 in 2014, 47 in 2015, 62 in 2016). Of these patients, 141 had NVAF-related AIS. Median length of hospital stay was 8 days (interquartile range [IQR], 6-11). In-hospital mortality was 10.8%. Ninety-eight patients (69.5%) received DOACs for secondary prevention, with increasing percentages from 2014 (62.5%) to 2016 (88%). In 88% of them, DOACs were started during hospital stay, whereas in 12% DOACs were started during ambulatory follow-up. The median time for starting DOACs was 5 days (IQR, 3-8). In patients receiving DOACs, the median National Institutes of Health Stroke Scale score was 6 (IQR, 3-12), and large ischemic lesions were present in 48%; the median modified Rankin Scale score at hospital discharge was 3 (IQR, 1-4), whereas the score at 90 days was 2 (IQR, 1-3). At the 90-day follow-up, in patients receiving DOACs, overall mortality was 3.0%, stroke recurrence was 1%, and no patients had major intracranial or extracranial bleedings. Conclusion Our study suggests that physicians are becoming increasingly confident in the use of DOACs in NVAF-related AIS. The use of DOACs seems effective and safe even when started in the acute phase of stroke.


  • 주제어

    Stroke .   dabigatran .   rivaroxaban .   apixaban .   edoxaban .   oral anticoagulants.  

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