Abstract W P238: Early Initiation of New Oral Anticoagulants May be Safe in Acute Stroke and TIA Patients with Nonvalvular Atrial Fibrillation
Background and Purpose: Recently, new oral anticoagulants (NOAC) such as the direct thrombin inhibitor and the factor Xa inhibitor have been developed and studied in multicenter, prospective, randomized trials. However, patients with acute stroke or transient ischemic attack (TIA) were not included into these studies. The aim of this study was to investigate whether early initiation of NOAC for acute stroke or TIA patients with nonvalvular atrial fibrillation (NVAF) are safe.
Methods: Between March 2011 and June 2013, stroke or TIA patients with NVAF who started NOAC within 2 weeks were enrolled retrospectively. Symptomatic intracerebral hemorrhage (ICH), hemorrhagic transformation (HT) on T2*-weighted MRI, recurrence of stroke or TIA, systemic embolism and any bleeding complications after initiation of NOAC were evaluated. Furthermore, we divided the patients into two groups according the presence of new HT after initiation of NOAC (new HT group and non HT group) and investigated the factors associated with new HT were investigated using multivariate logistic regression analysis.
Results: 70 patients (43 males; mean age 76.2 years) started NOAC; 64 (91%) patients had stroke, and 6 (9%) had TIA. The median (interquartile range) interval from onset to treatment with NOAC was 2 (1-6) days. Dabigatran was used in 55 patients (78.6%) and rivaroxaban in 15 (21.4%). None of the patients had recurrent stroke or TIA, systemic embolism. Symptomatic ICH during hospitalization was not observed. However, only one patient had symptomatic ICH at 49 days after stroke onset. HT on initial T2* and new HT on follow up T2* were 6 (8.6%) and 13(18.6%), respectively but they were asymptomatic. Of 6 patients who had HT on the initial T2*, enlargement of hemorrhage on follow-up T2* (hemorrhagic infarction (HI) Type 1→HI Type 2) was observed in 1 patient, but it was asymptomatic. Compared with the non-HT group, the HT group had a higher frequency of persistent AF, prior hypertension, and NIHSS score on admission. Multivariate logistic regression analysis showed that NIHSS score on admission >6 (Odds ratio, 51.2; 95% Confidence Interval, 3.916-669.944, P=0.003) was independently associated with new HT.
Conclusions: The NOAC may be safe in acute stroke or TIA patients with NVAF.
Author Disclosures: T. Ebata: None. K. Shibazaki: None. K. Sakai: None. J. Aoki: None. N. Saji: None. K. Kimura: None.
- © 2014 by American Heart Association, Inc.