ArticleAnnals of neurology2021
Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation.
Article in Annals of neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
77 citing papers in PubMed, 3 syntheses or guidelines pooled it, 131 citations in OpenAlex.
- Endovascular thrombectomy for acute stroke in anticoagulated patients: systematic review and Meta-Analysis.Journal of thrombosis and thrombolysis · 2026Pooled it
- Clinical characteristics and outcomes of ischemic stroke despite appropriate oral anticoagulation for atrial fibrillation: A systematic review and meta-analysis of real-world studies.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Pooled it
- Meta-analysis of outcomes following intravenous thrombolysis in patients with ischemic stroke on direct oral anticoagulants.BMC neurology · 2023Pooled it
- Early versus delayed anticoagulation in acute ischemic stroke with atrial fibrillation according to infarct volume and location: A prespecified subgroup analysis of the OPTIMAS randomized controlled trial.International journal of stroke : official journal of the International Stroke Society · 2026Trial
- Mobile health-technology integrated care in secondary prevention atrial fibrillation patients: a post-hoc analysis from the mAFA-II randomized clinical trial.Internal and emergency medicine · 2023Trial
- Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation.European heart journal · 2023Trial
- Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study.European heart journal · 2023Trial
- Beyond Sinus Rhythm: Rhythm Control and Mechanism-Based Secondary Prevention in Atrial Fibrillation-Related Stroke.Journal of atherosclerosis and thrombosis · 2026Review
- Letter to the editor regarding "Intracranial hemorrhage after ischemic stroke in patients on direct oral anticoagulants: results from a prospective observational study" by Purrucker et al.Neurological research and practice · 2026Article
- Safety of Endovascular Thrombectomy in Isolated Cervical Internal Carotid Artery Occlusion While on Oral Anticoagulation.Journal of stroke · 2026Article
- When anticoagulant therapy is not enough: recurrent stroke.European heart journal supplements : journal of the European Society of Cardiology · 2026Article
- Temporary Discontinuation and Restarting of Oral Anticoagulants for Neurological and Cardiac Indications.Deutsches Arzteblatt international · 2026Review
- The need for clinical studies assessing whether weight loss improves functional outcome after stroke in diabetes.BMC medicine · 2026Review
- Association Between Direct Oral Anticoagulants and the Risk of Internal Carotid Artery Occlusion in Patients Eligible for Thrombectomy.Clinical neuroradiology · 2026Observational
- Intracranial hemorrhage after ischemic stroke in patients on direct oral anticoagulants: results from a prospective observational study.Neurological research and practice · 2026Article
- Measurement of plasma direct oral anticoagulants concentrations in real-world clinical and laboratory settings on a 24/7 basis: a 10-year experience.Journal of thrombosis and thrombolysis · 2026Article
- Urine-based point-of-care detection of direct oral anticoagulant activity in acute stroke-accuracy at anti-Xa thresholds relevant for intravenous thrombolysis.Research and practice in thrombosis and haemostasis · 2026Article
- Impact of Direct Oral Anticoagulant Uptake on Hospitalizations for Stroke/Transient Ischemic Attack, Intracranial Hemorrhage, and Gastrointestinal Bleeding in Individuals With Atrial Fibrillation: A Population-Based Study.Fundamental & clinical pharmacology · 2025Article
- Trick or Treat(ment): Should We Still Fear Reperfusion Therapy in Anticoagulated Stroke Patients?-Comparable 90-Day Outcomes in a Propensity-Score-Matched Registry Study.Journal of clinical medicine · 2025Article
- Recent intake of direct oral anticoagulants and acute ischemic stroke: real world data from a comprehensive stroke center.Neurological research and practice · 2025Article
17 more citing papers are in PubMed but not listed here.
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Authors and funding
39 authors at 20 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3-month outcomes.
methodsThis was a cohort study of consecutive patients (2014-2019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0-2) at 3 months.
resultsOf 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2-11]) compared with VKA (6, [2-14]) and controls (7, [3-15], p < 0.001; quantile regression: β -2.1, 95% confidence interval [CI] -2.6 to -1.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50-0.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05-0.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6-4.7%) of controls, 9 of 195 (4.6%; 1.9-9.2%; aOR 0.93; 95% CI 0.46-1.90) patients on VKA and 2 of 65 (3.1%; 0.4-10.8%, aOR 0.56; 95% CI 0.28-1.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3-month outcome (aOR 1.24; 1.01-1.51).
interpretationPrior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3 months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2021;89:42-53.
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