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Updated: Jul 6, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Risk of stroke in patients with prior VKA or DOAC: A population-based real-world registry analysis
Lukas Mayer-Suess1, Heinrich Rinner2, Wilfried Lang3
1Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Direct oral anticoagulants (DOACs) are associated with a reduced risk of ischemic and hemorrhagic stroke compared to Vitamin-K antagonists. This finding highlights the need for optimized care protocols for stroke patients on oral anticoagulation.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Oral anticoagulation (OAC) risk assessment for stroke is limited.
- Previous studies focused on hospital cohorts and atrial fibrillation patients.
Purpose of the Study:
- To assess stroke risk in patients on OAC.
- To compare direct oral anticoagulants (DOACs) with Vitamin-K antagonists (VKAs).
Main Methods:
- Combined three Austrian datasets: Tyrolean Stroke Pathway, nationwide prescription data, and Austrian Stroke Unit Registry.
- Analyzed stroke risk and patient characteristics based on OAC type.
Main Results:
- 15.2% of ischemic and 25.0% of hemorrhagic stroke patients had prior OAC.
- DOACs were associated with reduced stroke risk versus VKAs (ischemic: RR 0.59; hemorrhagic: RR 0.68).
- DOACs linked to lower risk of acute large vessel occlusion stroke (RR 0.79).
Conclusions:
- Stroke is less frequent with DOACs compared to VKAs.
- Clear protocols are essential for managing acute stroke patients on OAC.
Introduction:
To date, risk assessment of suffering ischemic and hemorrhagic stroke in individuals under oral anticoagulation (OAC) is limited to hospital-based cohorts and patients with atrial fibrillation.
Patients And Methods:
Through the combination of three individual datasets, (1) the population-based Tyrolean Stroke Pathway database, prospectively documenting all (unselected) stroke patients in the entire federal state of the Tyrol and (2) nation-wide prescription data, detailing each reimbursed prescription in Austria as well as (3) the Austrian Stroke Unit Registry, a nation-wide registry comprising data on all patients admitted to any of the 38 stroke units in Austria, we assessed risk of stroke in patients with prior oral anticoagulation and compared characteristics of patients taking direct oral anticoagulants and Vitamin-K-Antagonists.
Results:
In Austria, oral anticoagulant prescription reimbursements increased from 292,475 in 2015 to 389,407 in 2021. In the Tyrol, prior oral anticoagulation treatment was evident in 586 of 3861 (15.2%) patients with ischemic and 131 of 523 (25.0%) with hemorrhagic stroke, with 20% and 35% of those stroke patients respectively having prior oral anticoagulation due to other indications than non-valvular atrial fibrillation. Considering prescription rates, treatment with direct oral anticoagulants was associated with a reduced stroke risk compared to Vitamin-K-Antagonists, especially in ischemic (1.05% vs 0.62%; RR 0.59, p < 0.001) but also in hemorrhagic stroke, even if less pronounced (0.21% vs 0.14%; RR 0.68, p = 0.06). In Austria, prior intake of direct oral anticoagulants was associated with lower risk of suffering acute large vessel occlusion stroke (RR 0.79, p = 0.003).
Discussion And Conclusions:
One in seven patients suffering ischemic and one in four suffering hemorrhagic stroke had prior oral anticoagulation treatment. Both ischemic and hemorrhagic strokes are less frequent in those with direct oral anticoagulant intake compared to those taking Vitamin-K-Antagonists. Establishment of clear standard operating procedures on how to best care for acute stroke patients with oral anticoagulation is essential.
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