Etiology of Ischemic Strokes of Patients with Atrial Fibrillation and Therapy with Anticoagulants
Abstract
:1. Introduction
2. Experimental Section
2.1. Patient Cohort Description, and Patient Involvement
2.2. Data Acquisition
2.3. Imaging Analysis
2.4. Etiologic Classification
2.5. Data Analysis
3. Results
3.1. Time Trends
3.2. Coagulation Status
3.3. Dosage Errors
3.4. Medication Errors
3.5. Etiologic Classification of OAC-Associated Strokes
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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VKA (n = 127) | NOAC (n = 214) | p-Value | |
---|---|---|---|
Age, mean (SD) | 79.4 (8.0) | 77.9 (8.9) | 0.119 |
Women | 57 (44.9) | 102 (47.7) | 0.654 |
NOAC | - | ||
Apixaban | - | 65 (30.4) | |
Dabigatran | - | 34 (15.9) | |
Edoxaban | - | 14 (6.5) | |
Rivaroxaban | - | 101 (47.2) | |
Low-dose NOAC | - | 97/197 (49.2) | |
Phenprocoumon | 125 (98.4) | - | |
Concomitant antiplatelet therapy | 3 (2.4) | 22 (10.3) | 0.009 |
Comorbidities | |||
Arterial hypertension | 112 (88.2) | 195 (91.1) | 0.455 |
Diabetes mellitus | 47 (37.0) | 71 (33.2) | 0.482 |
Hyperlipidemia | 51 (40.2) | 67 (31.3) | 0.101 |
Ischemic heart disease | 46 (36.2) | 75 (35.0) | 0.907 |
Myocardial infarction | 19 (15.0) | 30 (14.0) | 0.873 |
Peripheral artery disease | 16 (12.6) | 22 (10.3) | 0.594 |
Stroke/TIA | 39 (30.7) | 81 (37.9) | 0.198 |
Bleeding | 6 (4.7) | 14 (6.5) | 0.635 |
Smoking | 14 (11.0) | 34 (15.9) | 0.26 |
Malignancy, active | 4 (3.3) | 12 (5.9) | 0.428 |
Renal function at admission | |||
GFR; mean (SD) | 66.5 (22.3) | 68.2 (20.3) | 0.471 |
GFR < 50 mL/min | 26 (20.5) | 43 (20.1) | >0.99 |
GFR < 30 mL/min | 9 (7.1) | 8 (3.7) | 0.201 |
Lipid levels, serum, mg/dl mmol/L | |||
HDL cholesterol | 41 (34–51) 1.1 (0.9–1.3) | 44 (35–52) 1.1 (0.9–1.3) | 0.409 |
LDL cholesterol | 90 (68–112) 2.3 (1.8–2.9) | 97 (71–118) 2.5 (1.8–3.1) | 0.202 |
LDL cholesterol ≥ 70 mg/dl (≥1.8 mmol/L) | 89/120 (74.2) | 161/204 (78.9) | 0.34 |
Triglycerides | 104 (72–129) | 97 (71–128) | 0.355 |
Onset (last-seen-well in case exact onset is unknown) to admission *, hours | 3.7 (2.0–8.4) | 3.5 (1.5–7.0) | 0.445 |
Functional status | |||
Pre-stroke mRS | 2 (1–3) | 2 (1–3) | 0.943 |
mRS at admission | 4 (3–4) | 3 (2–4) | 0.251 |
mRS at discharge | 3 (2–4) | 3 (2–4) | 0.799 |
NIHSS at admission | 7 (3–17) | 3 (3–16) | 0.758 |
Imaging modality | |||
CT | 123 (96.9) | 210 (98.1) | 0.477 |
MRI | 32 (25.2) | 54 (25.2) | >0.99 |
Large-vessel occlusion | 61 (48.0) | 109 (50.9) | 0.654 |
IVT | 29 (22.8) | 16 (7.5) | <0.001 |
EVT | 41 (32.3) | 74 (34.6) | 0.723 |
CAS | 0 (0) | 4 (1.9) | 0.301 |
CEA | 1 (0.8) | 7 (3.3) | 0.266 |
Disease (Causality) | VKA (n = 127) | NOAC (n = 214) | p |
---|---|---|---|
Cardiac pathology (potential) | 127 | 214 | - |
Atherosclerosis (potential) | 13/125 (10.4) | 35/212 (16.5) | 0.147 |
Atherosclerosis (potential or uncertain) | 19/125 (15.2) | 42/212 (19.8) | 0.309 |
Small-vessel disease (potential) | 3 (2.4) | 13 (6.1) | 0.184 |
Small-vessel disease (potential or uncertain) | 21 (16.5) | 55 (25.7) | 0.059 |
Other causes (potential) | 0 (0) | 2 (0.9) | 0.531 |
Dissection (potential) | 0 (0) | 2 (0.9) | 0.531 |
Insufficient work-up (N9) | 2 (1.6) | 2 (0.9) | 0.63 |
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Purrucker, J.C.; Hölscher, K.; Kollmer, J.; Ringleb, P.A. Etiology of Ischemic Strokes of Patients with Atrial Fibrillation and Therapy with Anticoagulants. J. Clin. Med. 2020, 9, 2938. https://doi.org/10.3390/jcm9092938
Purrucker JC, Hölscher K, Kollmer J, Ringleb PA. Etiology of Ischemic Strokes of Patients with Atrial Fibrillation and Therapy with Anticoagulants. Journal of Clinical Medicine. 2020; 9(9):2938. https://doi.org/10.3390/jcm9092938
Chicago/Turabian StylePurrucker, Jan C., Kyra Hölscher, Jennifer Kollmer, and Peter A. Ringleb. 2020. "Etiology of Ischemic Strokes of Patients with Atrial Fibrillation and Therapy with Anticoagulants" Journal of Clinical Medicine 9, no. 9: 2938. https://doi.org/10.3390/jcm9092938