J Neurocrit Care.  2023 Dec;16(2):94-100. 10.18700/jnc.230031.

Effects of sufficient anticoagulation on ischemic stroke outcomes in patients with nonvalvular atrial fibrillation

• Kim TJ
• Park SH
• Kim Y
• Ko SB

• KMID: 2549486
• DOI: http://doi.org/10.18700/jnc.230031

Abstract

Background
Optimal anticoagulation therapy reduces the risk of ischemic stroke in patients with nonvalvular atrial fibrillation (AF). Therefore, we aimed to evaluate the effects of prior anticoagulation therapy with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) on ischemic stroke outcomes in patients with nonvalvular AF.
Methods
We enrolled 487 patients with ischemic stroke and nonvalvular AF between January 2013 and August 2020. The infarct volume was semi-automatically evaluated using diffusion-weighted magnetic resonance imaging. Patients were categorized into no anticoagulation, undertreated anticoagulation, and sufficient anticoagulation (with VKA or DOAC) groups based on their pre-admission anticoagulant use, and the clinical characteristics were compared between the groups.
Results
Among the included patients, 374 (76.8%), 50 (10.3%), 10 (2.1%), and 53 (10.9%) patients received no anticoagulants, were undertreated with a VKA, were sufficiently treated with a VKA, and received DOACs, respectively, before stroke. Multivariate analysis revealed that optimal anticoagulation was independently associated with a low risk of severe stroke (odds ratio, 0.553; 95% confidence interval, 0.308–0.992; P=0.047). Additionally, the DOAC group had a significantly smaller mean infarct volume than the other groups (45.8±73.2, 45.0±69.1, 30.9±24.7, and 12.6±24.9 mL in the no anticoagulation, insufficient VKA, sufficient VKA, and DOAC groups, respectively; P=0.011).
Conclusion
Sufficient pre-stroke anticoagulation is associated with mild stroke severity and good outcomes at 3 months post-stroke. Additionally, pre-stroke DOAC treatment is associated with smaller infarct volume in patients with ischemic stroke and nonvalvular AF.

Keyword

Anticoagulants; Atrial fibrillation; Ccerebral infarction

Figure

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  Fig. 1. Comparison of infarct volume according to pre-stroke anticoagulation. The sufficient anticoagulation group (sufficient vitamin K antagonist [VKA] and direct oral anticoagulants [DOACs]) had a lower infarct volume than no anticoagulation and undertreated VKA groups. Furthermore, the DOAC group had the lowest infarct volume by a significant margin among the four treatment groups.

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