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Direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: focus on real life studies

  • Luca MasottiEmail author
  • Elisa Grifoni
  • Alessandro Dei
  • Vieri Vannucchi
  • Federico Moroni
  • Grazia Panigada
  • Stefano Spolveri
  • Giancarlo Landini
Article

Abstract

Strong evidence for the use of direct oral anticoagulants (DOACs) in the early phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) is lacking, because this kind of patients were excluded from phase III randomized clinical trials (RCT) and ad hoc RCTs are ongoing. In the latest years a lot of real life studies on this topic have been published. The aim of our review was to focus on these. We reviewed the PubMed databases searching articles reporting on DOACs starting time within 2 weeks from AIS onset. We selected fifteen studies, eight with retrospective, six with prospective observational and one with a prospective, open-label, single arm design. Overall, 2920 patients (47.8% females) were included. In twelve studies median or mean age of patients was over 75 years. Mean or median NIHSS ad hospital admission was ≤ 12 in all studies. About one-third of patients (32.4%) received urgent reperfusion by systemic thrombolysis or mechanical thrombectomy. About one-fifth of patients (22.8%) had large infarct size. Median starting time of DOACs was reported in thirteen studies and it ranged from 2 to 8 days. About one-half of patients (45.9%) received a low dose of DOACs. In studies reporting on median or mean CHA2DS2-VASC score, it was ≥ 3 in all. In studies reporting on median or mean HAS-BLED score, it was ≥ 2 in all. Ninety-day follow-up was available for nine studies, overall including about 2200 patients. Incidence of 90-day TIA/stroke recurrence, symptomatic haemorrhagic transformation or intracranial bleeding and all cause mortality was 2.25%, 0.90% and 1.5%, respectively. The real life evidence suggests that early starting of DOACs in patients with NVAF-related AIS is safe and associated with low recurrence risk and all-cause mortality.

Keywords

Stroke Dabigatran Rivaroxaban Apixaban Edoxaban Direct oral anticoagulants 

Notes

Compliance with ethical standards

Conflict of interest

We declare that all the Authors have read and approved the final version of the manuscript entitle “Direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: focus on real life studies” and we have no conflicts of interest.

Research involving human participants and/or animals

The paper is an overview of already published real life studies on the use of Direct Oral Anticoagulants in the early phase of stroke in humans

Informed consent

It is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Luca Masotti
    • 1
    Email author
  • Elisa Grifoni
    • 1
  • Alessandro Dei
    • 1
  • Vieri Vannucchi
    • 2
  • Federico Moroni
    • 2
  • Grazia Panigada
    • 3
  • Stefano Spolveri
    • 4
  • Giancarlo Landini
    • 2
  1. 1.Internal Medicine II, Stroke Unit and Center of Thromboembolic DiseasesSan Giuseppe HospitalEmpoli, FlorenceItaly
  2. 2.Internal Medicine, Stroke Unit and Center of Thromboembolic DiseasesSanta Maria Nuova HospitalFlorenceItaly
  3. 3.Internal Medicine and Stroke UnitSS. Cosma and Damiano HospitalPesciaItaly
  4. 4.Internal Medicine and Stroke UnitBorgo San Lorenzo HospitalFlorenceItaly

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