title: Trends in oral anticoagulant choice for acute stroke patients with nonvalvular atrial fibrillation in Japan: the SAMURAI-NVAF study.
abstract: BACKGROUND
  Large clinical trials are lack of data on non-vitamin K antagonist oral anticoagulants for acute stroke patients.
  
  
  OBJECTIVE
  To evaluate the choice of oral anticoagulants at acute hospital discharge in stroke patients with nonvalvular atrial fibrillation and clarify the underlying characteristics potentially affecting that choice using the multicenter Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-NVAF registry (ClinicalTrials.gov NCT01581502).
  
  
  METHODS
  The study included 1192 acute ischemic stroke/transient ischemic attack patients with nonvalvular atrial fibrillation (527 women, 77·7 ± 9·9 years old) between September 2011 and March 2014, during which three nonvitamin K antagonist oral anticoagulant oral anticoagulants were approved for clinical use. Oral anticoagulant choice at hospital discharge (median 23-day stay) was assessed.
  
  
  RESULTS
  Warfarin was chosen for 650 patients, dabigatran for 203, rivaroxaban for 238, and apixaban for 25. Over the three 10-month observation periods, patients taking warfarin gradually decreased to 46·5% and those taking nonvitamin K antagonist oral anticoagulants increased to 48·0%. As compared with warfarin users, patients taking nonvitamin K antagonist oral anticoagulants included more men, were younger, more frequently had small infarcts, and had lower scores for poststroke CHADS2 , CHA2 DS2 -VASc, and HAS-BLED, admission National Institutes of Health stroke scale, and discharge modified Rankin Scale. Nonvitamin K antagonist oral anticoagulants were started at a median of four-days after stroke onset without early intracranial hemorrhage. Patients starting nonvitamin K antagonist oral anticoagulants earlier had smaller infarcts and lower scores for the admission National Institutes of Health stroke scale and the discharge modified Rankin Scale than those starting later. Choice of nonvitamin K antagonist oral anticoagulants was independently associated with 20-day or shorter hospitalization (OR 2·46, 95% CI 1·87-3·24).
  
  
  CONCLUSIONS
  Warfarin use at acute hospital discharge was still common in the initial years after approval of nonvitamin K antagonist oral anticoagulants, although nonvitamin K antagonist oral anticoagulant users increased gradually. The index stroke was milder and ischemia-risk indices were lower in nonvitamin K antagonist oral anticoagulant users than in warfarin users. Early initiation of nonvitamin K antagonist oral anticoagulants seemed safe.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Arihiro
authors.affiliation: Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Hyōgo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Todo
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Miyagi, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Furui
authors.affiliation: Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Terasaki
authors.affiliation: Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.affiliation: Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kamiyama
authors.affiliation: Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Shunya
authors.initials: S
authors.lastname: Takizawa
authors.affiliation: Department of Neurology, NHO Nagoya Medical Center, Nagoya, Chūbu, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okuda
authors.affiliation: Department of Neurology and Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Fukuoka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Division of Neurology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kameda
authors.affiliation: Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Honshu, Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Nagakane
authors.affiliation: Department of Neurology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.affiliation: Department of Neurology, South Miyagi Medical Center, Ogawara, Miyagi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mochizuki
authors.affiliation: Department of Neurology, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Cerebrovascular Medicine, NHO Kagoshima Medical Center, Kagoshima, Kagoshima, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takamatsu
authors.affiliation: Department of Neurology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Nishiyama
authors.affiliation: Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: acute stroke care; anticoagulation; atrial fibrillation; embolism; prevention