Initiation of direct oral anticoagulation after reperfusion therapy in ischemic stroke in clinical practice: Results from Sits-International Stroke Registry.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-03-14 DOI:10.1177/23969873251325978

Malin Säflund, Marius Matusevicius, Jose A Egido, José Manuel Ferro, Janika Kõrv, Maurizio Melis, André Peeters, Marco Petruzzellis, Viiu-Marika Rand, Aleksandras Vilionskis, Diana Melancia, Diana Aguiar de Sousa, Michael V Mazya, Tiago Moreira, Niaz Ahmed

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引用次数: 0

Abstract

Introduction: Data is limited on the safety of early initiation of direct oral anticoagulation (DOAC) treatment after acute ischemic stroke (AIS) receiving reperfusion therapy in patients with atrial fibrillation (AF). We investigated the timing of DOAC initiation and its association with safety and outcomes.

Materials and methods: We included AIS patients receiving reperfusion therapy with AF diagnosis (prevalent or new) registered in the Safe Implementation of Treatments in Stroke international registry during 2013-2024. Safety outcomes were hemorrhage and death. Secondary outcomes were recurrent AIS, any embolism and functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. We performed descriptive statistics and multivariable analysis for DOAC initiation time as an ordinal variable (0-3, 4-7, and 8-100 days after stroke onset) and its association with outcomes. Explorative analyses were performed to investigate factors associated with DOAC initiation time, as a continuous or ordinal variable.

Results: In total, 13,389 patients had data on DOAC initiation time, and 7861 patients had new event data by 3-month follow-up. We observed 0.1% intracranial hemorrhage, 0.4% major extracranial hemorrhage, 1.1% recurrent ischemic stroke, and 0.2% systemic embolism. At 3 months, 4.8% patients had died, and functional independence was seen in 60.9%. In multivariable analyses, DOAC initiation after stroke onset was not associated with any outcomes. Higher 24 h NIHSS and lower pre-stroke mRS score were associated with delayed DOAC initiation.

Conclusion: DOAC initiation time was not associated with any outcomes in AIS patients who received reperfusion therapy. Severe stroke symptoms at 24 h were associated with delayed DOAC initiation. The low incidence of safety outcomes and missing data in this study should lead to cautious interpretations of these results.

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临床实践中缺血性卒中再灌注治疗后直接口服抗凝剂的启动：来自sit -国际卒中登记的结果。

心房颤动（AF）患者在急性缺血性卒中（AIS）接受再灌注治疗后早期开始直接口服抗凝（DOAC）治疗的安全性数据有限。我们调查了DOAC起始时间及其与安全性和预后的关系。材料和方法：我们纳入了2013-2024年期间在卒中治疗安全实施国际登记处登记的接受再灌注治疗并诊断为房颤（现有或新发）的AIS患者。安全性结果为出血和死亡。次要结果为3个月时AIS复发、有无栓塞和功能独立性（改良Rankin量表[mRS] 0-2）。我们对DOAC起始时间作为顺序变量（卒中发病后0- 3,4 -7和8-100天）及其与预后的关系进行了描述性统计和多变量分析。探索性分析进行了调查的因素与DOAC启动时间，作为一个连续或有序的变量。结果：随访3个月，共有13389例患者有DOAC起始时间数据，7861例患者有新的事件数据。我们观察到0.1%颅内出血，0.4%颅内大出血，1.1%复发性缺血性脑卒中，0.2%全身栓塞。3个月时，4.8%的患者死亡，60.9%的患者功能独立。在多变量分析中，卒中发作后DOAC启动与任何结果无关。较高的24 h NIHSS和较低的卒中前mRS评分与DOAC启动延迟相关。结论：在接受再灌注治疗的AIS患者中，DOAC起始时间与任何预后无关。24小时的严重卒中症状与DOAC启动延迟相关。本研究中安全性结果的低发生率和数据缺失应导致对这些结果的谨慎解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.