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.
Data availability statement
Data are available upon reasonable request.
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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.
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