Next Article in Journal
Exosome-Derived microRNAs as Liquid-Biopsy Biomarkers in Laryngeal Squamous Cell Carcinoma: A Narrative Review and Evidence Map
Previous Article in Journal
Cellular and Molecular Mechanisms of Heart Failure and Sudden Cardiac Death in Hypertrophic Cardiomyopathy and Methods Used for Their Pathogenetic Correction
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Biomedicines
Volume 13
Issue 12
10.3390/biomedicines13122927
biomedicines-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Off-Label NOACs vs. Antiplatelets in AF-Related Stroke with GFR < 15 mL/Min/1.73 m2: A Multicenter Outcome Study

by
Jong-Hee Sohn
1,2,†,
Minwoo Lee
3,†,
Chulho Kim
1,2,
Joo Hye Sung
1,
Kyung-Ho Yu
3,
Yerim Kim
4,
Hee Jung Mo
5,
Jae Jun Lee
6 and
Sang-Hwa Lee
1,2,*
1
Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
2
Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea
3
Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
4
Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea
5
Department of Neurology, Inha University Hospital, Incheon 22332, Republic of Korea
6
Department of Anesthesiology and Pain, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Biomedicines 2025, 13(12), 2927; https://doi.org/10.3390/biomedicines13122927 (registering DOI)
Submission received: 21 September 2025 / Revised: 12 November 2025 / Accepted: 28 November 2025 / Published: 28 November 2025
(This article belongs to the Section Neurobiology and Clinical Neuroscience)
Versions Notes

Abstract

Background: This study aimed to evaluate the efficacy and safety of off-label use of non-vitamin K antagonist oral anticoagulants (NOACs) compared with antiplatelet therapy (APT) in patients with AF-related acute ischemic stroke (AIS) and a glomerular filtration rate (GFR) below 15 mL/min/1.73 m2. Methods: We used a multicenter prospective stroke registry to identify patients with AF-related AIS and GFR < 15 mL/min/1.73 m2 who were treated with either APT alone or NOAC alone at discharge. Primary outcomes were ischemic stroke recurrence, major bleeding, and all-cause mortality within one year. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. Results: Among 311 eligible patients, 135 (43.4%) received APT and 176 (56.6%) received low-dose NOACs. Compared to APT, NOAC use was associated with a significantly lower risk of ischemic stroke recurrence (aHR 0.54, 95% CI 0.29–0.99) but higher risks of major bleeding (aHR 3.25, 95% CI 1.84–5.73) and all-cause mortality (aHR 2.65, 95% CI 1.60–4.38). The most common causes of death were non-vascular events such as sepsis and respiratory failure. Conclusions: In patients with AF-related stroke and ultra-low GFR, off-label use of NOACs may offer a benefit in stroke prevention but is associated with increased risks of bleeding and mortality. These findings suggest the need for individualized treatment strategies and careful monitoring when prescribing NOACs in this vulnerable population.
Keywords: antiplatelet; NOAC; AF-related stroke; ultra-low GFR; end-stage renal disease; dialysis; stroke recurrence; major bleeding antiplatelet; NOAC; AF-related stroke; ultra-low GFR; end-stage renal disease; dialysis; stroke recurrence; major bleeding

Share and Cite

MDPI and ACS Style

Sohn, J.-H.; Lee, M.; Kim, C.; Sung, J.H.; Yu, K.-H.; Kim, Y.; Mo, H.J.; Lee, J.J.; Lee, S.-H. Off-Label NOACs vs. Antiplatelets in AF-Related Stroke with GFR < 15 mL/Min/1.73 m2: A Multicenter Outcome Study. Biomedicines 2025, 13, 2927. https://doi.org/10.3390/biomedicines13122927

AMA Style

Sohn J-H, Lee M, Kim C, Sung JH, Yu K-H, Kim Y, Mo HJ, Lee JJ, Lee S-H. Off-Label NOACs vs. Antiplatelets in AF-Related Stroke with GFR < 15 mL/Min/1.73 m2: A Multicenter Outcome Study. Biomedicines. 2025; 13(12):2927. https://doi.org/10.3390/biomedicines13122927

Chicago/Turabian Style

Sohn, Jong-Hee, Minwoo Lee, Chulho Kim, Joo Hye Sung, Kyung-Ho Yu, Yerim Kim, Hee Jung Mo, Jae Jun Lee, and Sang-Hwa Lee. 2025. "Off-Label NOACs vs. Antiplatelets in AF-Related Stroke with GFR < 15 mL/Min/1.73 m2: A Multicenter Outcome Study" Biomedicines 13, no. 12: 2927. https://doi.org/10.3390/biomedicines13122927

APA Style

Sohn, J.-H., Lee, M., Kim, C., Sung, J. H., Yu, K.-H., Kim, Y., Mo, H. J., Lee, J. J., & Lee, S.-H. (2025). Off-Label NOACs vs. Antiplatelets in AF-Related Stroke with GFR < 15 mL/Min/1.73 m2: A Multicenter Outcome Study. Biomedicines, 13(12), 2927. https://doi.org/10.3390/biomedicines13122927

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Article metric data becomes available approximately 24 hours after publication online.
Back to TopTop