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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2018.01095

Impact of non-vitamin K antagonist oral anticoagulant withdrawal on stroke outcomes

 Joong Hyun Park1,  Sang Won Han1, Kyung-Yul Lee2, Hye-Yeon Choi3, Kyeongyeol Cheon2, Han-Jin Cho4, Yo Han Jung5, Hyung Jong Park6,  HYO SUK NAM6, Ji Hoe Heo6,  Hye Sun Lee6,  Gustavo Saposnik7 and  Young Dae Kim6*
  • 1Inje University Sanggye Paik Hospital, South Korea
  • 2Gangnam Severance Hospital, South Korea
  • 3Kyung Hee University Hospital at Gangdong, Kyung Hee University, South Korea
  • 4Pusan National University Hospital, South Korea
  • 5Changwon Fatima Hospital, South Korea
  • 6Yonsei University College of Medicine, South Korea
  • 7St. Michael's Hospital, Canada

Introduction: Discontinuation of oral anticoagulants such as non-vitamin K antagonist oral anticoagulants (NOACs) may induce a hypercoagulable state, leading to severe stroke and poor outcomes. This study aimed to compare stroke outcomes between NOACs withdrawal and other prior medication status in patients with non-valvular atrial fibrillation (NVAF).
Methods: Consecutive patients who had pre-existing NVAF and were admitted for an acute ischemic stroke or transient ischemic attack at five hospitals between January 2013 and December 2016 were included. Prior medication status was categorized into seven groups such as no antithrombotics, antiplatelet-only, warfarin with subtherapeutic intensity, warfarin with therapeutic intensity, NOAC, warfarin withdrawal, and NOAC withdrawal. We compared initial National Institute of Health Stroke Scale (NIHSS) scores between groups
Results: Among 719 patients with NVAF, The median NIHSS score at admission was 5 (IQR 1-13). The NOAC withdrawal group had the highest median NIHSS scores at stroke onset (16, interquartile range, IQR [4-20]), followed by the warfarin withdrawal group (11, IQR [3-17]), the no antithrombotic group (5, IQR [2-16]), and the warfarin with subtherapeutic intensity group (5, IQR [2-13]). Multivariable analysis demonstrated that NOAC withdrawal was independently associated with higher NIHSS scores at stroke onset (B 4.645, 95% confidence interval 0.384–8.906, P=0.033). The median interval from drug withdrawal to ischemic stroke or TIA was 7 days (IQR 4-15) in the NOAC group.
Conclusions: Stroke occurred after discontinuing oral anticoagulants, particularly NOAC, was independently associated with severe stroke at presentation.

Keywords: Stroke, Non-valvular atrial fibrillation, Outcome, cardiac embolism, anticoagulation

Received: 15 Oct 2018; Accepted: 29 Nov 2018.

Edited by:

Antonio Arauz, Instituto Nacional de Neurología y Neurocirugía (INNN), Mexico

Reviewed by:

Christoph Gumbinger, Universität Heidelberg, Germany
Henry Ma, Monash University, Australia  

Copyright: © 2018 Park, Han, Lee, Choi, Cheon, Cho, Jung, Park, NAM, Heo, Lee, Saposnik and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Young Dae Kim, Yonsei University College of Medicine, Seoul, South Korea,