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Original research
Impact of prior use of antiplatelet agents and non-vitamin K antagonist oral anticoagulants on stroke outcomes among endovascular-treated patients with high pre-stroke CHA2DS2-VASc score
  1. Chulho Kim1,2,
  2. Jong-Hee Sohn1,2,
  3. Minwoo Lee3,
  4. Yerim Kim4,
  5. Hee Jung Mo5,
  6. Mi Sun Oh3,
  7. Kyung-Ho Yu3,
  8. Sang-Hwa Lee1,2
  1. 1 Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea (the Republic of)
  2. 2 Institute of New Frontier Research Team, Hallym University, Chuncheon, Korea (the Republic of)
  3. 3 Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea (the Republic of)
  4. 4 Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea (the Republic of)
  5. 5 Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (the Republic of)
  1. Correspondence to Dr Sang-Hwa Lee; bleulsh{at}naver.com

Abstract

Background We assessed the influence of prior non-vitamin K antagonist (NOAC) use on stroke outcomes after endovascular treatment (EVT) in patients at a high risk of stroke based on their pre-stroke CHA2DS2-VASc score, and compared them with those who did not use any antithrombotic (NAU) or antiplatelet (APT) agents.

Methods Data were collected from a multicenter database comprising consecutive acute ischemic stroke patients who underwent EVT during a span of 103 months. We evaluated pre-stroke CHA2DS2-VASc scores in enrolled patients and measured instances of successful reperfusion and symptomatic hemorrhagic transformation (SHT) following EVT as the main outcome measures.

Results Among 12 807 patients with acute ischemic stroke, 3765 (29.4%) had a history of atrial fibrillation. Of these, 418 patients with CHA2DS2-VASc scores ≥2 received EVT alone. The prior NOAC group showed higher successful reperfusion rates compared with the prior NAU and APT groups (p=0.04). Multivariate analysis revealed that prior NOAC use increased the likelihood of successful reperfusion after EVT (OR [95% CI] 2.54 [1.34 to 4.83], p=0.004) and improved stroke outcomes, while the prior APT group did not. Furthermore, the prior NOAC use group was not associated with SHT after EVT. Propensity score matching confirmed these findings.

Conclusion Prior use of NOAC is associated with improved outcomes in high-risk stroke patients (pre-stroke CHA2DS2-VASc score ≥2) undergoing EVT.

  • Thrombectomy
  • Stroke
  • Embolic
  • Intervention
  • Platelets

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors CK: Conceptualization, methodology, formal analysis, investigation, writing, and original draft preparation. S-HL: Conceptualization, data curation, original draft, review and editing, and supervision. J-HS: Data curation, and review and editing. YK: Data curation, and review and editing, HJM: Data curation, and review and editing. ML: Data curation, and review and editing. MSO: Data curation, and review and editing. K-HY: Data curation, and review and editing. All authors commented on draft versions of the manuscript and read and approved it in its final form. S-HL is responsible for the overall content as guarantor.

  • Funding This research was supported by Hallym University Medical Center Research Fund, supported by the Bio&Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No, RS-2023-00223501) and partly supported by the Basic Science Research Program of the National Research Foundation of Korea (NRF-2021R1G1A1013767) and a grant from the Korea Health Technology R&D project of the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HR21C0198) The funding organizations did not participate in the design, conduct, or analysis of the study or in the preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.