The severity of ischemic stroke and risk of all-cause mortality in patients with atrial fibrillation on different oral anticoagulant treatments admitted to the emergency department

Although direct oral anticoagulants (DOACs) are non-inferior to Vitamin K antagonists (VKA) in preventing ischemic stroke (IS) in atrial fibrillation (AF) patients, there are limited data regarding stroke severity and prognosis of patients admitted with IS during DOAC treatment. We performed a single center retrospective study including patients with AF on oral anticoagulants admitted to the Emergency Department for IS were included. The primary endpoint was to analyse the severity of stroke evaluated through NIHSS scale according to anticoagulant therapy. The secondary endpoint was 3-month all-cause mortality. A total of 106 AF patients were included, with a mean age of 81.3 ± 7.5 years. Overall, 54.7% were women and 61.3% on DOAC. The AF patients on DOAC were older, with no other clinical differences. Median NIHSS was 12 (Interquartile Range [IQR] 5-19). At multivariable logistic regression analysis DOAC use (compared to warfarin) was associated with lower risk of moderate-severe/severe stroke (NIHSS ≥ 16) (Odds Ratio [OR] 0.355, 95% confidence interval [95% CI] 0.127-0.995). Mechanical thrombectomy was strongly associated with higher severity of stroke (OR 6.113, 95%CI 2.186-17.099). During follow-up, 42 patients died. DOAC use inversely correlated with mortality risk (OR 0.323, 95%CI 0.127-0.822) after adjusting for CHA₂DS₂-VASc, time to hospital admission from symptom onset and type of acute treatment. In conclusion, in our contemporary real-world population, patients on DOACs treatment admitted for IS had better outcomes in terms of stroke severity and all-cause mortality compared with patients on VKAs.