title: Severity and Functional Outcome of Patients with Cardioembolic Stroke Occurring during Non-vitamin K Antagonist Oral Anticoagulant Treatment.
abstract: BACKGROUND
  Severity and functional outcome of patients with cardioembolic stroke (CE) occurring during non-vitamin K antagonist oral anticoagulant (NOAC) treatment remain uncertain.
  
  
  METHODS
  The consecutive 355 CE patients within 48 hours after onset and with modified Rankin Scale (mRS) score of 1 or less before onset were studied. Of all, 262 patients were treated with no anticoagulants (non-AC), 63 with warfarin below therapeutic range of prothrombin time-international normalized ratio (PT-INR) on admission (PT-INR <1.6 [WF-Lo]), 16 with warfarin within therapeutic range (PT-INR ≥1.6 [WF-Tp]), and 14 with NOACs (9 dabigatran and 5 rivaroxaban [NOAC-DR]). We compared severity and functional outcome of CE patients among these 4 groups, especially focusing on patients during NOAC treatment.
  
  
  RESULTS
  Stroke severity on admission, assessed by the National Institutes of Health Stroke Scale, was lower in WF-Tp (median, 5 [1-15]) and NOAC-DR (5 [3-6]) than in non-AC (11 [5-19]) and WF-Lo (12 [5-19]; P = .006). Functional outcome at discharge, assessed by mRS, was favorable in WF-Tp (median, 1 [0-4]) and NOAC-DR (1 [1-2]) compared with that in non-AC (2 [1-4]) and WF-Lo (3 [1-5]; P = .02), and ratios of the patients with mRS score of 1 or less were 63% and 64% versus 31% and 33%, respectively (P = .005). Multivariate analysis also showed a favorable functional outcome at discharge in WF-Tp and NOAC-DR groups. Drug management was likely associated with NOAC-associated CE.
  
  
  CONCLUSIONS
  Stroke severity and functional outcome of CE patients treated with warfarin within therapeutic range and with NOACs are similar to each other, and are more favorable than those with no anticoagulants and with warfarin below therapeutic range.
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Hagii
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Metoki
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Saito
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shiroto
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Hitomi
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Takaatsu
authors.initials: T
authors.lastname: Kamada
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Seino
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yasujima
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. Electronic address: okumura@hirosaki-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Cardioembolic stroke; atrial fibrillation; non-vitamin K antagonist oral anticoagulant; warfarin