Sakamoto Y, et al. – Researchers carried out this study to examine the effect of direct oral anticoagulants (DOACs) on initial stroke severity in patients with acute ischemic stroke (AIS) and non–valvular atrial fibrillation (NVAF). In patients with AIS and NVAF, DOAC treatment prior to the event had to reduce initial stroke severity.

Methods

• The researchers recruited consecutive AIS patients having NVAF from March 2011 through July 2016.
• They assessed the effects of prior DOAC treatment on severity by multivariate logistic regression analyses.

Results

• The researchers enrolled 484 patients (208 women; median age 79 [interquartile range 71-85] years; NIHSS score 9 [3-20]).
• Out of them, 352 (73%) were on no anticoagulant medication, 54 (11%) were undertreated with a VKA, 35 (7%) were sufficiently treated (admission PT-INR ≥ 2.0 for patients <70 years and PT-INR ≥1.6 for ≥70 years old) with a VKA, and 43 (9%) were on a DOAC.
• Among the groups, the initial NIHSS (median 10 in patients with no anticoagulation, 13 in undertreated VKA, 7 in sufficient VKA, and 6 in DOAC, p=0.018) was different.
• Multivariate analysis demonstrated that compared to no anticoagulant therapy, DOAC was independently and negatively correlated with severe (initial NIHSS ≥10) stroke (OR 0.39, p=0.041).