Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose

Yo Han Jung, Hye Yeon Choi, Kyung Yul Lee, Kyeongyeol Cheon, Sang Won Han, Joong Hyun Park, Han Jin Cho, Hyung Jong Park, Hyo Suk Nam, Jihoe Heo, Hye Sun Lee, Young Dae Kim

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background The stroke severity or functional outcomes could differ because the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) could be different according to the dose. We investigated whether there was any difference in the stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) by their prior medication status, including standard-dosed versus under-dosed NOACs. Materials and Methods We enrolled 858 patients with acute ischaemic stroke with chronic NVAF admitted at six hospitals in Korea. We categorized their prior medication status as follows: (1) no anti-thrombotics (n = 219), (2) only anti-platelet (n = 347), (3) warfarin with a sub-therapeutic intensity (n = 185), (4) warfarin with a therapeutic intensity (n = 37), (5) under-dosed NOAC (n = 27) and (6) standard-dosed NOAC (n = 43). We compared the initial stroke severity between groups. Results Among the 858 patients, the patients on standard-dosed NOACs had the lowest initial National Institute of Health Stroke Scale (NIHSS) score, followed by those on warfarin with a therapeutic intensity and those on only anti-platelet (p < 0.05). Multivariate analysis demonstrated that the NIHSS score was significantly low in the patients on warfarin with a therapeutic intensity (B, -5.602; 95% confidence interval [CI], -8.636 to -2.568; p < 0.001) or those on standard-dosed NOACs (B, -3.588; 95% CI, -6.405 to -0.771; p = 0.013), while there was no difference in the NIHSS score between the patients not taking any anti-thrombotics and those on warfarin with a sub-therapeutic intensity or under-dosed NOACs. Conclusion Use of warfarin with a therapeutic intensity or standard-dosed NOACs was associated with a relatively mild stroke in the patients with NVAF.

Original languageEnglish
Pages (from-to)2145-2151
Number of pages7
JournalThrombosis and Haemostasis
Volume118
Issue number12
DOIs
Publication statusPublished - 2018 Jan 1

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Anticoagulants
Warfarin
Stroke
National Institutes of Health (U.S.)
Atrial Fibrillation
Therapeutics
Blood Platelets
Confidence Intervals
Korea
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Jung, Y. H., Choi, H. Y., Lee, K. Y., Cheon, K., Han, S. W., Park, J. H., ... Kim, Y. D. (2018). Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose. Thrombosis and Haemostasis, 118(12), 2145-2151. https://doi.org/10.1055/s-0038-1675602
Jung, Yo Han ; Choi, Hye Yeon ; Lee, Kyung Yul ; Cheon, Kyeongyeol ; Han, Sang Won ; Park, Joong Hyun ; Cho, Han Jin ; Park, Hyung Jong ; Nam, Hyo Suk ; Heo, Jihoe ; Lee, Hye Sun ; Kim, Young Dae. / Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose. In: Thrombosis and Haemostasis. 2018 ; Vol. 118, No. 12. pp. 2145-2151.
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title = "Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose",
abstract = "Background The stroke severity or functional outcomes could differ because the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) could be different according to the dose. We investigated whether there was any difference in the stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) by their prior medication status, including standard-dosed versus under-dosed NOACs. Materials and Methods We enrolled 858 patients with acute ischaemic stroke with chronic NVAF admitted at six hospitals in Korea. We categorized their prior medication status as follows: (1) no anti-thrombotics (n = 219), (2) only anti-platelet (n = 347), (3) warfarin with a sub-therapeutic intensity (n = 185), (4) warfarin with a therapeutic intensity (n = 37), (5) under-dosed NOAC (n = 27) and (6) standard-dosed NOAC (n = 43). We compared the initial stroke severity between groups. Results Among the 858 patients, the patients on standard-dosed NOACs had the lowest initial National Institute of Health Stroke Scale (NIHSS) score, followed by those on warfarin with a therapeutic intensity and those on only anti-platelet (p < 0.05). Multivariate analysis demonstrated that the NIHSS score was significantly low in the patients on warfarin with a therapeutic intensity (B, -5.602; 95{\%} confidence interval [CI], -8.636 to -2.568; p < 0.001) or those on standard-dosed NOACs (B, -3.588; 95{\%} CI, -6.405 to -0.771; p = 0.013), while there was no difference in the NIHSS score between the patients not taking any anti-thrombotics and those on warfarin with a sub-therapeutic intensity or under-dosed NOACs. Conclusion Use of warfarin with a therapeutic intensity or standard-dosed NOACs was associated with a relatively mild stroke in the patients with NVAF.",
author = "Jung, {Yo Han} and Choi, {Hye Yeon} and Lee, {Kyung Yul} and Kyeongyeol Cheon and Han, {Sang Won} and Park, {Joong Hyun} and Cho, {Han Jin} and Park, {Hyung Jong} and Nam, {Hyo Suk} and Jihoe Heo and Lee, {Hye Sun} and Kim, {Young Dae}",
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Jung, YH, Choi, HY, Lee, KY, Cheon, K, Han, SW, Park, JH, Cho, HJ, Park, HJ, Nam, HS, Heo, J, Lee, HS & Kim, YD 2018, 'Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose', Thrombosis and Haemostasis, vol. 118, no. 12, pp. 2145-2151. https://doi.org/10.1055/s-0038-1675602

Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose. / Jung, Yo Han; Choi, Hye Yeon; Lee, Kyung Yul; Cheon, Kyeongyeol; Han, Sang Won; Park, Joong Hyun; Cho, Han Jin; Park, Hyung Jong; Nam, Hyo Suk; Heo, Jihoe; Lee, Hye Sun; Kim, Young Dae.

In: Thrombosis and Haemostasis, Vol. 118, No. 12, 01.01.2018, p. 2145-2151.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stroke Severity in Patients on Non-Vitamin K Antagonist Oral Anticoagulants with a Standard or Insufficient Dose

AU - Jung, Yo Han

AU - Choi, Hye Yeon

AU - Lee, Kyung Yul

AU - Cheon, Kyeongyeol

AU - Han, Sang Won

AU - Park, Joong Hyun

AU - Cho, Han Jin

AU - Park, Hyung Jong

AU - Nam, Hyo Suk

AU - Heo, Jihoe

AU - Lee, Hye Sun

AU - Kim, Young Dae

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background The stroke severity or functional outcomes could differ because the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) could be different according to the dose. We investigated whether there was any difference in the stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) by their prior medication status, including standard-dosed versus under-dosed NOACs. Materials and Methods We enrolled 858 patients with acute ischaemic stroke with chronic NVAF admitted at six hospitals in Korea. We categorized their prior medication status as follows: (1) no anti-thrombotics (n = 219), (2) only anti-platelet (n = 347), (3) warfarin with a sub-therapeutic intensity (n = 185), (4) warfarin with a therapeutic intensity (n = 37), (5) under-dosed NOAC (n = 27) and (6) standard-dosed NOAC (n = 43). We compared the initial stroke severity between groups. Results Among the 858 patients, the patients on standard-dosed NOACs had the lowest initial National Institute of Health Stroke Scale (NIHSS) score, followed by those on warfarin with a therapeutic intensity and those on only anti-platelet (p < 0.05). Multivariate analysis demonstrated that the NIHSS score was significantly low in the patients on warfarin with a therapeutic intensity (B, -5.602; 95% confidence interval [CI], -8.636 to -2.568; p < 0.001) or those on standard-dosed NOACs (B, -3.588; 95% CI, -6.405 to -0.771; p = 0.013), while there was no difference in the NIHSS score between the patients not taking any anti-thrombotics and those on warfarin with a sub-therapeutic intensity or under-dosed NOACs. Conclusion Use of warfarin with a therapeutic intensity or standard-dosed NOACs was associated with a relatively mild stroke in the patients with NVAF.

AB - Background The stroke severity or functional outcomes could differ because the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) could be different according to the dose. We investigated whether there was any difference in the stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) by their prior medication status, including standard-dosed versus under-dosed NOACs. Materials and Methods We enrolled 858 patients with acute ischaemic stroke with chronic NVAF admitted at six hospitals in Korea. We categorized their prior medication status as follows: (1) no anti-thrombotics (n = 219), (2) only anti-platelet (n = 347), (3) warfarin with a sub-therapeutic intensity (n = 185), (4) warfarin with a therapeutic intensity (n = 37), (5) under-dosed NOAC (n = 27) and (6) standard-dosed NOAC (n = 43). We compared the initial stroke severity between groups. Results Among the 858 patients, the patients on standard-dosed NOACs had the lowest initial National Institute of Health Stroke Scale (NIHSS) score, followed by those on warfarin with a therapeutic intensity and those on only anti-platelet (p < 0.05). Multivariate analysis demonstrated that the NIHSS score was significantly low in the patients on warfarin with a therapeutic intensity (B, -5.602; 95% confidence interval [CI], -8.636 to -2.568; p < 0.001) or those on standard-dosed NOACs (B, -3.588; 95% CI, -6.405 to -0.771; p = 0.013), while there was no difference in the NIHSS score between the patients not taking any anti-thrombotics and those on warfarin with a sub-therapeutic intensity or under-dosed NOACs. Conclusion Use of warfarin with a therapeutic intensity or standard-dosed NOACs was associated with a relatively mild stroke in the patients with NVAF.

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