Abstract
Background:
The benefits of parenteral anticoagulation in noncardioembolic stroke are still unclear.
Aims:
The aim of this study was to clarify the association between intravenous anticoagulation (IVAC) and clinical outcome in patients with acute noncardioembolic stroke.
Methods:
The study had an observational design and analyzed data from the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database. A total of 33,184 patients were identified to have presented with acute noncardioembolic stroke between 2017 and 2020. After exclusion of patients with incomplete IVAC data, those with a premorbid modified Rankin Scale (mRS) score of 3–5, those who received thrombolysis or endovascular therapy, and those with atrial fibrillation, we examined the association between IVAC and clinical outcomes, including mRS score at discharge and the frequency of severe bleeding episodes during hospitalization.
Results:
In total, 8967 patients were enrolled. The mean age was 71.8 ± 12.3 years, 64.9% were male, and the median initial National Institutes of Health Stroke Scale score was 2. Of these 8967 patients, 5708 (63.7%) received IVAC, 6425 (71.6%) had mRS score of 0–2 at discharge, and 33 (0.4%) experienced severe bleeding. In multivariable logistic regression analysis, IVAC was associated with lower odds of mRS 0–2 at discharge (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.73–0.94) but not with severe bleeding (OR 0.94, 95% CI 0.45–1.99). In subgroup analysis, a significant interaction (p < 0.001) indicated effect modification by dual antiplatelet therapy (DAPT) status, with a stronger association between IVAC and reduced odds of mRS 0–2 in patients not receiving DAPT.
Conclusions:
In this Japanese cohort, although assessed at discharge, IVAC was associated with lower odds of favorable early outcome after noncardioembolic stroke, likely influenced by selection bias, and the safety findings were inconclusive due to the small number of events
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