Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence
Introduction. The optimal timing for starting anticoagulation in the early phase of nonvalvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains a challenge, especially in patients undergoing urgent reperfusion by systemic thrombolysis or mechanical thrombectomy. The aim of our...
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Wiley
2019-01-01
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| Series: | Neurology Research International |
| Online Access: | http://dx.doi.org/10.1155/2019/9657073 |
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| author | Luca Masotti Elisa Grifoni Alessandro Dei Vieri Vannucchi Federico Moroni Grazia Panigada Costanza Nicotra Stefano Spolveri Giancarlo Landini |
| author_facet | Luca Masotti Elisa Grifoni Alessandro Dei Vieri Vannucchi Federico Moroni Grazia Panigada Costanza Nicotra Stefano Spolveri Giancarlo Landini |
| author_sort | Luca Masotti |
| collection | DOAJ |
| description | Introduction. The optimal timing for starting anticoagulation in the early phase of nonvalvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains a challenge, especially in patients undergoing urgent reperfusion by systemic thrombolysis or mechanical thrombectomy. The aim of our study was to review the literature evidence reporting on safety of direct oral anticoagulants (DOACs) starting in the early phase of NVAF-related AIS undergoing systemic thrombolysis and/or mechanical thrombectomy. Materials and Methods. We reviewed the PubMed databases searching articles reporting on efficacy and safety of DOACs starting time within two weeks from AIS onset in patients undergoing systemic thrombolysis and/or mechanical thrombectomy. Results. Three studies were selected, overall including one hundred and six patients (62 females, 58.4%). Median National Institute of Health Stroke Scale (NIHSS) score at hospital admission ranged from 9 to 13 points. Median DOACs starting time ranged from 2 to 6 days. Median CHA2DS2-VASC score ranged from 4 to 6 points. Follow-up was limited to 14 days in one study, 30 days in another, and 90 days in a third one. Overall, stroke recurrence and/or intracranial bleeding occurred in two patients (1.9%) and no patient died at follow-up. Conclusion. Small sample size real life studies seem to demonstrate that the introduction of DOACs in the early phase of NVAF-related AIS undergoing urgent reperfusion is efficacious and safe. Prospective RCTs are necessary to confirm these findings. |
| format | Article |
| id | doaj-art-ff090c9f1ec045a38c3a212138ced36e |
| institution | OA Journals |
| issn | 2090-1852 2090-1860 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Neurology Research International |
| spelling | doaj-art-ff090c9f1ec045a38c3a212138ced36e2025-08-20T02:22:45ZengWileyNeurology Research International2090-18522090-18602019-01-01201910.1155/2019/96570739657073Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature EvidenceLuca Masotti0Elisa Grifoni1Alessandro Dei2Vieri Vannucchi3Federico Moroni4Grazia Panigada5Costanza Nicotra6Stefano Spolveri7Giancarlo Landini8Internal Medicine, Stroke Unit and Center of Thromboembolic Diseases, San Giuseppe Hospital, Empoli (Florence), ItalyInternal Medicine, Stroke Unit and Center of Thromboembolic Diseases, San Giuseppe Hospital, Empoli (Florence), ItalyInternal Medicine, Stroke Unit and Center of Thromboembolic Diseases, San Giuseppe Hospital, Empoli (Florence), ItalyInternal Medicine, Stroke Unit and Center of Thromboembolic Diseases, Santa Maria Nuova Hospital, Florence, ItalyInternal Medicine, Stroke Unit and Center of Thromboembolic Diseases, Santa Maria Nuova Hospital, Florence, ItalyInternal Medicine and Stroke Unit, SS. Cosma and Damiano Hospital, Pescia (Pistoia), ItalyInternal Medicine and Stroke Unit, Borgo San Lorenzo Hospital, Florence, ItalyInternal Medicine and Stroke Unit, Borgo San Lorenzo Hospital, Florence, ItalyInternal Medicine, Stroke Unit and Center of Thromboembolic Diseases, Santa Maria Nuova Hospital, Florence, ItalyIntroduction. The optimal timing for starting anticoagulation in the early phase of nonvalvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains a challenge, especially in patients undergoing urgent reperfusion by systemic thrombolysis or mechanical thrombectomy. The aim of our study was to review the literature evidence reporting on safety of direct oral anticoagulants (DOACs) starting in the early phase of NVAF-related AIS undergoing systemic thrombolysis and/or mechanical thrombectomy. Materials and Methods. We reviewed the PubMed databases searching articles reporting on efficacy and safety of DOACs starting time within two weeks from AIS onset in patients undergoing systemic thrombolysis and/or mechanical thrombectomy. Results. Three studies were selected, overall including one hundred and six patients (62 females, 58.4%). Median National Institute of Health Stroke Scale (NIHSS) score at hospital admission ranged from 9 to 13 points. Median DOACs starting time ranged from 2 to 6 days. Median CHA2DS2-VASC score ranged from 4 to 6 points. Follow-up was limited to 14 days in one study, 30 days in another, and 90 days in a third one. Overall, stroke recurrence and/or intracranial bleeding occurred in two patients (1.9%) and no patient died at follow-up. Conclusion. Small sample size real life studies seem to demonstrate that the introduction of DOACs in the early phase of NVAF-related AIS undergoing urgent reperfusion is efficacious and safe. Prospective RCTs are necessary to confirm these findings.http://dx.doi.org/10.1155/2019/9657073 |
| spellingShingle | Luca Masotti Elisa Grifoni Alessandro Dei Vieri Vannucchi Federico Moroni Grazia Panigada Costanza Nicotra Stefano Spolveri Giancarlo Landini Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence Neurology Research International |
| title | Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence |
| title_full | Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence |
| title_fullStr | Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence |
| title_full_unstemmed | Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence |
| title_short | Direct Oral Anticoagulants in Patients Undergoing Urgent Reperfusion for Nonvalvular Atrial Fibrillation-Related Ischemic Stroke: A Brief Report on Literature Evidence |
| title_sort | direct oral anticoagulants in patients undergoing urgent reperfusion for nonvalvular atrial fibrillation related ischemic stroke a brief report on literature evidence |
| url | http://dx.doi.org/10.1155/2019/9657073 |
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