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Infarct Volumes of Patients with Acute Ischemic Stroke Receiving Direct Oral Anticoagulants due to Non-Valvular
Nese G Yavasoglu1, Yasemin Eren1, Idil G Tatar2
1Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Abstract:
Direct oral anticoagulants (DOACs) have been shown to decrease the risk of ischemic stroke in non-valvular atrial fibrillation (NVAF). This study aims to investigate whether DOACs result in a significant change in lesion volume and the severity of the subsequent disability in patients who have experienced a stroke.
Methods:
The study included a total of 137 patients with NVAF and acute stroke. The cohort included 76 patients using DOACs, 21 patients using acetylsalicylic acid (ASA), and 40 patients with newly diagnosed atrial fibrillation (NDAF) who did not use antiaggregants or anticoagulants. Diffusion-weighted MRI was performed 6-12 hours after the first stroke symptoms and infarct volumes were measured by two independent observers. Baseline National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score at discharge and period of hospitalization were calculated.
Results:
When patients using DOACs due to NVAF and patients with NDAF were compared, the volumes of patients using DOACs (median 7.8 vs 23.1 cm3; P ≤ 0.01) were statistically significantly smaller. However, there was no difference in volume between ASA users (median 16.9 cm3; P = 0.16) and patients with NDAF. The DOACs group was significantly different compared to the NDAF group in terms of NIHSS scores (median 4.4 vs 8.3; P ≤ 0.01) and mRS scores at discharge (median 1.7 vs 2.7; P ≤ 0.01), and period of hospitalization (median 6.4 vs 10.4 days; P ≤ 0.01).
Conclusion:
We observe, while using DOACs, the infarct volumes of patients who experience stroke are smaller than those with NDAF and using ASA, as well as mRS scores at discharge are low and length of hospital stay is short.
Insights
Direct oral anticoagulants (DOACs) significantly reduce stroke lesion volume and disability in non-valvular atrial fibrillation (NVAF) patients. DOAC use correlates with smaller infarcts and better outcomes compared to no anticoagulation.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Non-valvular atrial fibrillation (NVAF) increases ischemic stroke risk.
- Direct oral anticoagulants (DOACs) are established for stroke risk reduction in NVAF.
- The impact of DOACs on acute stroke lesion volume and patient outcomes requires further investigation.
Purpose of the Study:
- To evaluate the effect of DOACs on infarct volume in acute stroke patients with NVAF.
- To assess the correlation between DOAC use and stroke severity, including National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores.
- To compare outcomes in DOAC users versus patients on acetylsalicylic acid (ASA) and those with newly diagnosed atrial fibrillation (NDAF) without anticoagulation.
Main Methods:
- A cohort study of 137 NVAF patients with acute stroke.
- Categorization into three groups: DOAC users (n=76), ASA users (n=21), and NDAF without antiplatelets/anticoagulants (n=40).
- Diffusion-weighted MRI for infarct volume measurement; NIHSS, mRS, and hospitalization duration recorded.
Main Results:
- DOAC users exhibited significantly smaller infarct volumes (median 7.8 cm³ vs. 23.1 cm³ in NDAF; P ≤ 0.01).
- No significant volume difference was observed between ASA users and NDAF patients (median 16.9 cm³ vs. 23.1 cm³; P = 0.16).
- DOAC users showed significantly lower NIHSS scores (4.4 vs. 8.3; P ≤ 0.01), lower mRS scores at discharge (1.7 vs. 2.7; P ≤ 0.01), and shorter hospital stays (6.4 vs. 10.4 days; P ≤ 0.01) compared to NDAF patients.
Conclusions:
- DOACs are associated with reduced infarct volumes in stroke patients with NVAF.
- DOAC therapy correlates with improved functional outcomes and shorter hospitalizations post-stroke.
- Findings support the efficacy of DOACs in mitigating stroke severity and improving recovery in NVAF patients.
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