Early initiation of rivaroxaban after reperfusion therapy for stroke patients with nonvalvular atrial fibrillation

Junpei Koge, Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Hiroshi Yamagami, Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Kazunori Toyoda, Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Masahiro Yasaka, Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Clinical Research Institute, Fukuoka, Japan.
Teruyuki Hirano, Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan.
Toshimitsu Hamasaki, The George Washington University Biostatistics Center, Rockville, Maryland, United States of America.
Takehiko Nagao, Department of Neurology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
Shinichi Yoshimura, Department of Neurosurgery, Hyogo College of Medicine, Hyogo, Japan.
Masahito Fujishige, Department of Neurosurgery, Shinsapporo Neurosurgical Hospital, Sapporo, Japan.
Akira Tempaku, Department of Neurosurgery, Hokuto Hospital, Obihiro, Japan.
Shinichiro Uchiyama, Clinical Research Center for Medicine, Center for Brain and Cerebral Vessels, Sanno Medical Center, International University of Health and Welfare Director, Tokyo, Japan.
Etsuro Mori, Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Suita, Japan.
Masatoshi Koga, Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Kazuo Minematsu, Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

Document Type

Journal Article

Publication Date

1-1-2022

Journal

PloS one

Volume

17

Issue

4

DOI

10.1371/journal.pone.0264760

Abstract

BACKGROUND: The optimal timing of initiating oral anticoagulants after reperfusion therapy for ischemic stroke is unknown. Factors related to early initiation of rivaroxaban and differences in clinical outcomes of stroke patients with nonvalvular atrial fibrillation (NVAF) who underwent reperfusion therapy was investigated. METHODS: From data of 1,333 NVAF patients with ischemic stroke or transient ischemic attack (TIA) in a prospective multicenter study, patients who started rivaroxaban after intravenous thrombolysis and/or mechanical thrombectomy were included. The clinical outcomes included the composite of ischemic events (recurrent ischemic stroke, TIA, or systemic embolism) and major bleeding at 3 months. RESULTS: Among the 424 patients, the median time from index stroke to starting rivaroxaban was 3.2 days. On multivariable logistic regression analysis, infarct size (odds ratio [OR], 0.99; 95%CI, 0.99-1.00) was inversely and successful reperfusion (OR, 2.13; 95%CI, 1.24-3.72) was positively associated with initiation of rivaroxaban within 72 hours. 205 patients were assigned to the early group (< 72 hours) and 219 patients (≥ 72 hours) to the late group. Multivariable Cox regression models showed comparable hazard ratios between the two groups at 3 months for ischemic events (hazard ratio [HR], 0.18; 95%CI, 0.03-1.32) and major bleeding (HR, 1.80; 95%CI, 0.24-13.54). CONCLUSIONS: Infarct size and results of reperfusion therapy were associated with the timing of starting rivaroxaban. There were no significant differences in the rates of ischemic events and major bleeding between patients after reperfusion therapy who started rivaroxaban < 72 hours and ≥ 72 hours after the index stroke. CLINICAL TRIAL REGISTRATION: Unique identifier: NCT02129920; URL: https://www.clinicaltrials.gov.

Department

Biostatistics and Bioinformatics

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