title: Clinical Features of Ischemic Stroke during Treatment with Dabigatran: An Association between Decreased Severity and a Favorable Prognosis.
abstract: OBJECTIVE
  Anticoagulation therapy with warfarin is associated with a favorable prognosis in ischemic stroke. Dabigatran, a new oral anticoagulant, is widely used to prevent ischemic stroke in non-valvular atrial fibrillation (NVAF) patients. However, its association with decreased severity and a favorable prognosis once ischemic stroke has occurred remains unknown.
  
  
  METHODS
  We retrospectively reviewed all the patients with NVAF-associated ischemic stroke admitted to our hospital from April 2011 to December 2014 and included those who received dabigatran therapy. We assessed whether the patients were under regular use of the drug or discontinuance and classified them into 2 groups, the treatment and discontinuation groups. Clinical data, including the age, sex, ASCOD stroke phenotype, NVAF type, prescribed drug dose, comorbidities, CHADS2 score, renal function, National Institute of Health Stroke Scale (NIHSS) score on admission, modified Rankin scale (mRS) score at discharge, D-dimer, and brain natriuretic peptide, were investigated and compared between the groups.
  
  
  RESULTS
  Nine patients were under regular dabigatran therapy, and 6 were under discontinuance of the drug. The age, sex, ASCOD stroke phenotype, NVAF type, comorbidities, renal function, and CHADS2 scores did not differ between the 2 groups; however, the NIHSS scores were significantly lower in the treatment group. The mRS scores at discharge were additionally decreased in the treatment group. Moreover, the D-dimer scores were lower in the treatment group, thus suggesting a possible role in the decreased stroke severity.
  
  
  CONCLUSIONS
  Dabigatran may therefore decrease the severity of ischemic stroke, even if ischemic stroke occurs.
authors.affiliation: Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.forename: Hajime
authors.initials: H
authors.lastname: Maruyama
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Horiuchi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Sano
authors.forename: Yuito
authors.initials: Y
authors.lastname: Nagamine
authors.forename: Satoko
authors.initials: S
authors.lastname: Mizuno
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000517:prevention & control*; D015897:Comorbidity; D000069604:Dabigatran / Q000627:therapeutic use*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D020097:Natriuretic Peptide, Brain; D014859:Warfarin; D000069604:Dabigatran