Oral Presentation Asia Pacific Stroke Conference 2024

The efficacy and safety of intravenous anticoagulants for non-cardioembolic stroke: the Japan Stroke Data Bank (106762)

Ryo Itabashi 1 , Sohei Yoshimura 2 , Masatoshi Koga 2 , Michikazu Nakai 2 3 , Yoshihiro Miyamoto 2 , Kenichi Matsumoto 4 , Yoshiki Yagita 5 , Makoto Inaba 6 , Masateru Katayama 7 , Yukako Yazawa 8 , Takeo Hatano 9 , Yasuhisa Yoshida 10 , Naomichi Wada 11 , Kenji Kamiyama 12 , Kuniaki Ogasawara 1 , Kazunori Toyoda 2 , Kazuo Minematsu 13
  1. Iwate Medical University, Yahaba, IWATE, Japan
  2. National Cerebral and Cardiovascular Center, Suita
  3. University of Miyazaki Hospital, Miyazaki
  4. Saga-Ken Medical Center Koseikan, Saga
  5. Kawasaki Medical School, Kurashiki
  6. Saiseikai Yokohamashi Tobu Hospital, Yokohama
  7. Tokyo Dental College Ichikawa General Hospital, Ichikawa
  8. Kohnan Hospital, Sendai
  9. Kokura Memorial Hospital, Kitakyushu
  10. Yoshida Hospital Cerebrovascular Research Institute, Kobe
  11. Suwa Redcross Hospital, Suwa
  12. Nakamura Memorial Hospital, Sapporo
  13. ISEIKAI International General Hospital, Osaka

Backgrounds: Argatroban for acute stroke has been reevaluated; however, the evidence of intravenous anticoagulants (IVAC) including argatroban is still not established. The aim of this study is to determine the efficacy and safety of IVAC for non-cardioembolic stroke.

Methods: This was an observational study using the Japan Stroke Data Bank, a hospital-based multicenter registry. Of 33184 patients with acute non-cardioembolic stroke presented between 2017 to 2020, following patients were excluded: incomplete data of IVAC, premorbid mRS 3-5, treated with thrombolysis or endovascular therapy, or with atrial fibrillation. We retrospectively examined the association between IVAC and outcome including mRS at discharge or severe bleedings during hospitalization.

Result: We enrolled 8967 patients(71.8±12.3 years-old, 64.9% were male). Median initial NIHSS score was 2, 5708 (63.7%) was treated with IVAC (46.3% argatroban), 6425 （71.6％）was mRS 0-2 at discharge, and 33 (0.4％) had severe bleedings. In multivariable logistic regression analysis, IVAC was inversely associated with mRS 0-2 at discharge (OR 0.85, 95% CI 0.75-0.96), but not associated with severe bleedings (OR 1.91, 95%CI 0.63-5.75)．In subgroup analysis, IVAC was inversely associated with mRS 0-2 in patients with NIHSS >4 (OR 0.70, 95% CI 0.57-0.88), and in those with DAPT (dual antiplatelet therapy) (OR 0.73, 95% CI 0.61-0.88, but not in those with NIHSS≤4 (OR 0.90, 95% CI 0.78-1.04), and in those without DAPT (OR 0.93, 95% CI 0.79-1.10).

Conclusion: IVAC for non-cardioembolic stroke was inversely associated with favorable outcome, especially in patients with moderate to severe symptoms or DAPT, but not associated with severe bleedings.