Early start of DOAC after ischemic stroke Risk of intracranial hemorrhage and recurrent events

被引:100
作者
Seiffge, David J. [1 ,2 ,3 ]
Traenka, Christopher [1 ,2 ]
Polymeris, Alexandros [1 ,2 ]
Hert, Lisa [1 ,2 ]
Peters, Nils [1 ,2 ]
Lyrer, Philippe [1 ,2 ]
Engelter, Stefan T. [1 ,2 ,4 ,5 ]
Bonati, Leo H. [1 ,2 ]
De Marchis, Gian Marco [1 ,2 ]
机构
[1] Univ Basel Hosp, Dept Neurol, Basel, Switzerland
[2] Univ Basel Hosp, Stroke Ctr, Basel, Switzerland
[3] Univ Basel, Basel, Switzerland
[4] Univ Basel, Neurorehabil Unit, Basel, Switzerland
[5] Felix Platter Hosp, Univ Ctr Med Aging, Basel, Switzerland
关键词
ATRIAL-FIBRILLATION; ORAL ANTICOAGULANTS; SUBGROUP ANALYSIS; WARFARIN; DABIGATRAN; ATTACK;
D O I
10.1212/WNL.0000000000003283
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. Methods: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs). Follow-up was at least 3 months. In the primary analysis, we compared rates of ICH and recurrent ischemic events (AIS or TIA) between patients with early (<= 7 days since event; DOAC(early)) and those with late (>7 days, DOAC(late)) start of DOAC. Results: Two hundred four patients were included (median age 79 years, 89% AIS) and total follow-up time was 78.25 patient-years. One hundred fifty-five patients received DOAC with a median delay of 5 days after the index event (interquartile range 3-11) and 49 received VKA. DOAC was started early in 100 patients (65%). We observed one ICH (1.3%/y) and 6 recurrent AIS (7.7%/y). The ICH occurred in a patient taking VKA. No significant difference in the rate of recurrent AIS between DOAC(early) (5.1%/y) and DOAC(late) (9.3%/y, p = 0.53) was observed. Conclusions: Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.
引用
收藏
页码:1856 / 1862
页数:7
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