Optimal timing and safety of non-vitamin K antagonist oral anticoagulant for atrial-fibrillation-related ischemic stroke

抄録

BACKGROUND

In atrial-fibrillation (AF)-related acute ischemic stroke (AIS), the optimal timing for starting or resuming non-vitamin K antagonist oral anticoagulants (NOAC) remains unknown. We aimed to determine the optimal timing of NOAC initiation for AF-related AIS using the Japanese Diagnosis Procedure Combination inpatient database.

METHODS

We retrospectively collected data of adult inpatients who were admitted with a diagnosis of AF-related AIS from July 2010 to March 2016. Patients were divided into tertiles of hospital days for initiating NOAC (early, delayed, and late groups). Incidence of hemorrhagic events or NOAC discontinuation was the primary outcome. Secondary outcome included in-hospital death, any hemorrhagic event, thrombotic events, and deterioration of modified Rankin scale from admission to discharge. Logistic regression analyses were performed to compare the primary and secondary outcomes among the three groups with adjustments for patient backgrounds using inverse probability of treatment weighting by propensity score analysis.

RESULTS

We identified 55,289 eligible patients, including 17,810 in the early group (3–5 days), 18,473 in the delayed group (6–10 days), and 19,006 in the late group (≥11 days). Logistic regression analyses indicated the odds ratio for the primary outcome in the late group was not significant (adjusted odds ratio, 1.08; 95% confidence interval, 1.0–1.16).

CONCLUSIONS

NOAC initiation within 3–5 days was safer and associated with the lower proportions of the secondary outcomes in patients with AF-related AIS.