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. 2024 Nov 1;29(6):329-338.
doi: 10.1097/NRL.0000000000000579.

Clinical Features, Management, and Recurrence of Acute Ischemic Stroke Occurring in Patients on Oral Anticoagulant Treatment for Nonvalvular Atrial Fibrillation: A Real-World Retrospective Study

Elisa Grifoni  1 , Beatrice Pagni  1 , Teresa Sansone  1 , Mariella Baldini  2 , Elisabetta Bertini  2 , Sara Giannoni  2 , Ilaria Di Donato  2 , Irene Sivieri  1 , Gina Iandoli  1 , Marianna Mannini  1 , Elisa Giglio  1 , Vincenzo Vescera  1 , Eleonora Brai  1 , Ira Signorini  1 , Eleonora Cosentino  1 , Irene Micheletti  1 , Elisa Cioni  1 , Giulia Pelagalli  1 , Alessandro Dei  1 , Antonio Giordano  1 , Francesca Dainelli  1 , Mario Romagnoli  1 , Chiara Mattaliano  1 , Elena Schipani  1 , Giuseppe Salvatore Murgida  1 , Stefania Di Martino  1 , Valentina Francolini  1 , Luca Masotti  1
Affiliations

Clinical Features, Management, and Recurrence of Acute Ischemic Stroke Occurring in Patients on Oral Anticoagulant Treatment for Nonvalvular Atrial Fibrillation: A Real-World Retrospective Study

Elisa Grifoni et al. Neurologist. .

Abstract

Objectives: The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA for nonvalvular atrial fibrillation (NVAF).

Methods: We retrospectively analyzed data on NVAF patients with AIS on direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) admitted to our Stroke Unit from 2017 to 2022. Ninety-day modified Rankin Scale (mRS), 90-day, and 12-month stroke recurrences were recorded.

Results: A total of 169 patients (53.2% female, mean age 82.8±6.7 y), 117 (69.2%) on DOAC, and 52 on VKA (30.8%), were enrolled. Mean age, in-hospital mortality, and 90-day mRS ≥4 were significantly higher in VKA patients. 63.4% of VKA patients had subtherapeutic INR, whereas 47.1% of DOAC patients were on low-dose (14.2% off-label). Large vessel occlusion and embolic etiology were more frequent in VKA patients (34.6% vs. 26.4%, P =0.358; 92.3% vs. 74.3%, P =0.007, respectively), whereas lacunar strokes were more frequent in DOAC patients (19.8% vs. 12.2%, P =0.366). Among patients on VKA before AIS 86.4% were switched to DOAC, whereas a DOAC-to-VKA and a DOAC-to-DOAC switch were done in 25.4% and 11.7%, respectively. Stroke recurrence occurred in 6.4% of patients at 90 days and 10.7% at 12 months. Anticoagulant switching was not associated with stroke recurrences.

Conclusions: In our study, nonembolic etiology was more frequent in DOAC patients and anticoagulant switching did not reduce the risk of stroke recurrence. Prospective multicentric studies are warranted.

Trial registration: ClinicalTrials.gov NCT05963698.

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Conflict of interest statement

The authors declare no conflict of interest.

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