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INFLUENCE OF ORAL ANTICOAGULATION IN STROKE SEVERITY AND OUTCOMES: A PROPENSITY SCORE MATCHED CASE-CONTROL STUDY

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ESOC-2019

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Abstract

Background and purpose: Oral anticoagulants (OAC) such as vitamin K antagonist (VKA) and direct-acting OAC (DOAC) remain the mainstay for prevention of cardioembolic stroke. However, the influence of previous OAC treatment on stroke severity and outcomes is not well stablished. We analyzed a cohort of incident cardioembolic strokes according to pre-stroke treatment. Methods: Retrospective observational study of patients with cardioembolic stroke admitted to a stroke center from 2014 to 2017. Demographic data, vascular risk factors, pre-stroke treatments, reperfusion therapies and outcomes were analyzed. We used propensity score matching of baseline characteristics to create comparable case-control 1:1 samples across different treatment groups: adequate VKA anticoagulation vs inadequate VKA; inadequate VKA vs no OAC; adequate VKA vs DOAC. Results: 462 patients (mean age 76±11.6 years). 255 (55%) had a known major cardioembolic source before stroke, only 151 (59%) of them were under OAC on admission (127 VKA, 24 DOAC). Four patients were under VKA for other reasons. From those taking VKA, 91 (69%) had an inadequate anticoagulation on admission. After propensity score matching, we found no significant differences in stroke severity, reperfusion treatments, or independence at 3 months across different groups. Patients under DOAC showed lower mortality at 3 months (8% vs 33%, p=.033) and a trend towards lower NIHSS scores on admission (6vs11, p=.14), and shorter recanalization times (median 50vs118, p=.13) compared with adequate VKA anticoagulation. Conclusion: DOAC treatment significantly reduced mortality at three months compared with adequate VKA anticoagulation. Further studies are needed to confirm their influence on recanalization times.

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© Copyright 2020 Morressier GmbH.
All rights reserved.