Early Administration of Non-Vitamin K Antagonist Oral Anticoagulants for Acute Ischemic Stroke Patients With Atrial Fibrillation in Comparison With Warfarin Mostly Combined With Heparin
Eiichi Nomura, Tomohiko Ohshita, Eiji Imamura, Shinichi Wakabayashi, Hiroshi Kajikawa, Naohisa Hosomi, Masayasu Matsumoto
2015
Circulation Journal
862 NOMURA E et al. Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp Furthermore, recent studies demonstrated that diffusionweighted images (DWIs) of magnetic resonance imaging (MRI) detected more than a few new lesions at the acute or subacute stage of AIS, 8-10 and this was also suggested to be a surrogate marker for subsequent recurrence of stroke. 8 In cases of AIS with Af, it was reported that the rate of recurrent new lesions on DWIs was
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... . 8, 9 We also reported the frequency of new lesions on DWIs at 2 weeks from admission to be 28.5% under early warfarinization, with a median starting day of the second day, and found that achieving the targeted prothrombin timeinternational normalized ratio (PT-INR) at 2 weeks was associated with a lower frequency of new lesions. 11 Recently, some non-vitamin K antagonist oral anticoagulants (NOACs) were developed and have been reported to have equivalent or more power than warfarin to reduce stroke recurrence ardioembolic stroke is the most severe type of acute ischemic stroke (AIS). 1,2 Compared with other types of stroke, patients with cardioembolic stroke are prone to early (1-10%) 1,2 and long-term stroke recurrence (2-15% in the first year). 3 It has been reported that atrial fibrillation (Af) is a leading risk factor and accounts for approximately threequarters of cardioembolic stroke. 1,2 An oral anticoagulation drug, warfarin, can reduce the recurrence of cardioembolic stroke due to Af by 66%, 3 as well as a 64% reduction in primary prevention. 4 Although recurrence after cardioembolic stroke frequently occurs during the acute stage, 1,2 the efficacy of intravenous anticoagulant therapy like heparin has not been proven, 5-7 and the timing of starting warfarin for those patients is still unclear. Background: This study evaluated the rates of new lesions on diffusion-weighted images (DWIs) of magnetic resonance imaging (MRI) and hemorrhagic transformation (HT) during 2 weeks after acute ischemic stroke (AIS) in patients with atrial fibrillation (Af) who were given one of the non-vitamin K antagonist oral anticoagulants (NOACs); this was then compared with those who were given warfarin. Methods and Results: Consecutive AIS patients with Af were enrolled between January 2008 and June 2013, and those selected were patients who had a MRI that included DWIs both on admission and after 2 weeks, and those given only wafrarin (warfarin group) or only one of the NOACs (NOAC group) within 2 weeks of admission. Of all 257 enrolled patients, 50 patients were selected for the NOAC group (median age of 80.0 years) and 125 patients for the warfarin group (median age of 80.0 years). Both NOAC and warfarin were started at a median of the second day after admission. There was no significant difference in the rates of new lesions on DWIs (26.0% vs. 28.0%, P=0.7888) and HT (30.0% vs. 39.2%, P=0.2536) between the NOAC and warfarin groups. The NOAC group had a lower rate of concomitant use of heparin (44.0% vs. 92.8%, P<0.0001) than the warfarin group. Conclusions: This study suggests that NOACs are suitable for AIS patients with Af, perhaps even better than warfarin, given their simplicity. (Circ J 2015; 79: 862 -866)
doi:10.1253/circj.cj-14-0793
pmid:25736910
fatcat:hb533gypvjgfvejjhsf6pk62vi