Portuguese Observational Study of Ischaemic Stroke in Patients Medicated with Non-Vitamin K Antagonist Oral Anticoagulants

José Beato-Coelho, João Pedro Marto, José Nuno Alves, Cláudia Marques-Matos, Sofia Calado, José Araújo, Luís Cunha, João Pinho, Elsa Azevedo, Miguel Viana-Baptista, João Sargento-Freitas
European Neurology 2018, 79 (1-2): 108-112

INTRODUCTION: Clinical trials and subsequent meta-analyses showed advantages of non-vitamin K antagonists oral anticoagulants (NOACs) over vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation. The impact of preadmission anticoagulation in acute ischaemic stroke (AIS) has not been established.

OBJECTIVE: To compare functional outcome of patients with AIS with preadmission NOACs vs. VKAs.

METHODS: A retrospective analysis was conducted on consecutive AIS patients under oral anticoagulation (VKAs or NOACs) admitted in 4 Portuguese hospitals within a period of 30 months. Two primary outcomes were defined and compared between VKA and NOAC groups: symptomatic intracerebral hemorrhage transformation (sICH) and modified Rankin Scale (mRS) at 3 months.

RESULTS: Four hundred sixty-nine patients were included, of whom 332 (70.8%) were treated with VKA and 137 (29.2%) with NOAC. Patients' median age was 78.0 and 234 (49.9%) were male. NOAC-treated patients had a higher median CHA2DS2-VASc score than those under VKA (5.0 vs. 4.0, p = 0.023). The two primary outcomes showed no statistical differences between the VKAs' group and the NOACs' group (sICH: 5.4 vs. 5.4% [p = 0.911]; mRS at 3 months: 3.0 vs. 3.0 [p = 0.646], respectively).

CONCLUSION: Preadmission anticoagulation with NOACs in AIS has a functional impact similar to that of VKAs.


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