Abstract
Objective: We investigated recurrent stroke volume with nonvalvular atrial fibrillation (NVAF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) about clinical backgrounds and number of recurrent stroke. Methods: We administered three NOACs, dabigatran, rivaroxaban and apixaban in 84 post cardioembolic stroke with NVAF. In retrospective study, we measured recurrent stroke volume with MRI volumetry soft and compared them between 7 vitamin K anticoagulant (VKA: warfarin) cases and 10 NOACs cases under anticoagulant therapy. Results: Of 84 cases, 27 cases were started with VKA and switched to NOACs after 7 recurrent stroke. Other 57 cases were directly started with NOACs and 10 cases with NOACs as first anticoagulants had recurrent stroke. The frequency of recurrent stroke during anticoagulant therapy are not different among VKA group and three NOACs group. Recurrent stroke volume is significantly larger in VKA group (27.4 cm3) than in NOACs group (3.3cm3). Conclusions: Secondary prevention with NOACs after stroke might be more beneficial by reducing recurrent infarct volume than VKA.
Highlights
Non-vitamin K antagonist oral anticoagulants (NOACs) have gradually changed anticoagulant therapy with non-inferiority to vascular event and decreasing major bleeding in atrial fibrillation and venous thrombosis [1,2,3,4]
In 27 (32%) of 84 cases with using vitamin K anticoagulant (VKA), 7 cases had been switched into NOACs with recurrent stroke, and 20 cases had been switched into NOACs without any event
We showed the clinical background of VKA group and three NOACs group
Summary
Non-vitamin K antagonist oral anticoagulants (NOACs) have gradually changed anticoagulant therapy with non-inferiority to vascular event and decreasing major bleeding in atrial fibrillation and venous thrombosis [1,2,3,4]. We examined the recurrent stroke volumes and clinical outcome under taking NOACs and compared with recurrent cases under vitamin K anticoagulant (VKA: warfarin). In table 2, we can recognize the baseline characteristics of recurrent or no recurrent case with each anticoagulant, VKA or NOACs. In recurrent case the VKA group had lower body weight and higher risk score with stroke event predicted by CHA2DS2-VASc score (similar to comparison in no recurrent) and HAS-BLED score.
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