Evidence map›Paper›PMID 35135063›Full record

ArticleJournal of stroke2022

Low Exposure to Direct Oral Anticoagulants Is Associated with Ischemic Stroke and Its Severity.

Timolaos Rizos, Andreas D Meid, Andrea Huppertz, Chris Dumschat, Jan Purrucker, Kathrin I Foerster, Jürgen Burhenne, David Czock, Ekkehart Jenetzky, Peter A Ringleb and 1 more

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of stroke, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 18 citations in OpenAlex.

  1. Trial
  2. Article
  3. Observational
  4. Article
  5. Article
  6. Article
  7. Observational
  8. Observational
  9. DOAC plasma concentration upon hospital admission in a cohort of trauma patients. An observational real-life study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023
    Observational
  10. Review
  11. Article
  12. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Timolaos RizosDepartment of Neurology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Andreas D MeidDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Andrea HuppertzDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Chris DumschatDepartment of Neurology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Jan PurruckerDepartment of Neurology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Kathrin I FoersterDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Jürgen BurhenneDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
David CzockDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Ekkehart JenetzkyFaculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany.
Peter A RinglebDepartment of Neurology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Walter E HaefeliDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany.
Heidelberg University · DEWitten/Herdecke University · DE

Funding

Medical Faculty of Heidelberg University
6 · The paper itself

Abstract

background and purposeIn acute stroke patients, plasma concentrations of direct oral anticoagulants (DOAC) at hospital admission only poorly mirror DOAC exposure or the coagulation status at the time of the event. Here, we evaluated whether DOAC exposure and DOAC plasma concentration at the time of transient ischemic attacks (TIA) and ischemic strokes correlate with their likelihood of occurrence.

methodsProspectively, consecutive DOAC patients with acute ischemic stroke or TIA were included. Admission DOAC plasma concentrations were measured by ultraperformance liquid chromatography- tandem mass spectrometry. Individual DOAC exposure (area under the curve) and DOAC concentrations at event onset were derived from population pharmacokinetic analyses.

resultsDOAC exposure was successfully modeled in 211 patients (ischemic stroke 74.4%, TIA 25.6%). Compared to published values, 63.0% had relatively lower DOAC exposure and they more often received lower DOAC doses than recommended (odds ratio [OR], 2.125; 95% confidence interval [CI], 1.039 to 4.560; P=0.044). These patients more likely suffered ischemic strokes than TIA (OR, 2.411; 95% CI, 1.254 to 4.638; P=0.008) and their strokes were more severe (slope, 3.161; 95% CI, 0.741 to 5.58; P=0.011). Low relative DOAC concentrations at event onset were likewise associated with ischemic strokes (OR, 4.123; 95% CI, 1.834 to 9.268; P=0.001), but not to stroke severity (P=0.272). DOAC exposure had a higher explanatory value for stroke severity than concentrations at event.

conclusionsLow DOAC exposure is strongly associated to ischemic stroke and its severity. By monitoring DOAC plasma concentrations, patients prone to ischemic stroke might be identified.

Indexed as

AnticoagulantsIschemic attack, transientIschemic strokePlasmaTandem mass spectrometry

Identifiers

PMID35135063
PMCPMC8829480
OpenAlexW4210669219

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.