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Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events.
- Source :
-
Neurology [Neurology] 2016 Nov 01; Vol. 87 (18), pp. 1856-1862. Date of Electronic Publication: 2016 Sep 30. - Publication Year :
- 2016
-
Abstract
- Objective: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up.<br />Methods: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs). Follow-up was at least 3 months. In the primary analysis, we compared rates of ICH and recurrent ischemic events (AIS or TIA) between patients with early (≤7 days since event; DOAC <subscript>early</subscript> ) and those with late (>7 days, DOAC <subscript>late</subscript> ) start of DOAC.<br />Results: Two hundred four patients were included (median age 79 years, 89% AIS) and total follow-up time was 78.25 patient-years. One hundred fifty-five patients received DOAC with a median delay of 5 days after the index event (interquartile range 3-11) and 49 received VKA. DOAC was started early in 100 patients (65%). We observed one ICH (1.3%/y) and 6 recurrent AIS (7.7%/y). The ICH occurred in a patient taking VKA. No significant difference in the rate of recurrent AIS between DOAC <subscript>early</subscript> (5.1%/y) and DOAC <subscript>late</subscript> (9.3%/y, p = 0.53) was observed.<br />Conclusions: Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.<br /> (© 2016 American Academy of Neurology.)
- Subjects :
- Administration, Oral
Aged
Aged, 80 and over
Brain Ischemia complications
Electrocardiography
Female
Follow-Up Studies
Humans
Male
Recurrence
Retrospective Studies
Risk Factors
Stroke etiology
Vitamin K antagonists & inhibitors
Vitamin K therapeutic use
Anticoagulants adverse effects
Intracranial Hemorrhages chemically induced
Secondary Prevention
Stroke drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1526-632X
- Volume :
- 87
- Issue :
- 18
- Database :
- MEDLINE
- Journal :
- Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 27694266
- Full Text :
- https://doi.org/10.1212/WNL.0000000000003283