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Int J Stroke. 2015 Aug;10(6):836-42. doi: 10.1111/ijs.12452. Epub 2015 Jan 12.

Trends in oral anticoagulant choice for acute stroke patients with nonvalvular atrial fibrillation in Japan: the SAMURAI-NVAF study.

Author information

1
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
2
Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Hyōgo, Japan.
3
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
4
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
5
Department of Stroke Neurology, Kohnan Hospital, Sendai, Miyagi, Japan.
6
Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan.
7
Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
8
Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan.
9
Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
10
Department of Neurology, NHO Nagoya Medical Center, Nagoya, Chūbu, Japan.
11
Department of Neurology and Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Fukuoka, Japan.
12
Division of Neurology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
13
Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Honshu, Japan.
14
Department of Neurology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
15
Department of Neurology, South Miyagi Medical Center, Ogawara, Miyagi, Japan.
16
Department of Neurology, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
17
Department of Cerebrovascular Medicine, NHO Kagoshima Medical Center, Kagoshima, Kagoshima, Japan.
18
Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
19
Department of Neurology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
20
Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.

Abstract

BACKGROUND:

Large clinical trials are lack of data on non-vitamin K antagonist oral anticoagulants for acute stroke patients.

AIM:

To evaluate the choice of oral anticoagulants at acute hospital discharge in stroke patients with nonvalvular atrial fibrillation and clarify the underlying characteristics potentially affecting that choice using the multicenter Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-NVAF registry (ClinicalTrials.gov NCT01581502).

METHOD:

The study included 1192 acute ischemic stroke/transient ischemic attack patients with nonvalvular atrial fibrillation (527 women, 77·7 ± 9·9 years old) between September 2011 and March 2014, during which three nonvitamin K antagonist oral anticoagulant oral anticoagulants were approved for clinical use. Oral anticoagulant choice at hospital discharge (median 23-day stay) was assessed.

RESULTS:

Warfarin was chosen for 650 patients, dabigatran for 203, rivaroxaban for 238, and apixaban for 25. Over the three 10-month observation periods, patients taking warfarin gradually decreased to 46·5% and those taking nonvitamin K antagonist oral anticoagulants increased to 48·0%. As compared with warfarin users, patients taking nonvitamin K antagonist oral anticoagulants included more men, were younger, more frequently had small infarcts, and had lower scores for poststroke CHADS2 , CHA2 DS2 -VASc, and HAS-BLED, admission National Institutes of Health stroke scale, and discharge modified Rankin Scale. Nonvitamin K antagonist oral anticoagulants were started at a median of four-days after stroke onset without early intracranial hemorrhage. Patients starting nonvitamin K antagonist oral anticoagulants earlier had smaller infarcts and lower scores for the admission National Institutes of Health stroke scale and the discharge modified Rankin Scale than those starting later. Choice of nonvitamin K antagonist oral anticoagulants was independently associated with 20-day or shorter hospitalization (OR 2·46, 95% CI 1·87-3·24).

CONCLUSIONS:

Warfarin use at acute hospital discharge was still common in the initial years after approval of nonvitamin K antagonist oral anticoagulants, although nonvitamin K antagonist oral anticoagulant users increased gradually. The index stroke was milder and ischemia-risk indices were lower in nonvitamin K antagonist oral anticoagulant users than in warfarin users. Early initiation of nonvitamin K antagonist oral anticoagulants seemed safe.

KEYWORDS:

acute stroke care; anticoagulation; atrial fibrillation; embolism; prevention

PMID:
25581108
PMCID:
PMC4964913
DOI:
10.1111/ijs.12452
[Indexed for MEDLINE]
Free PMC Article

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