Recurrence of stroke in patients with AF using NOACs

Abstract

Objective: To evaluate the risk factors of recurrent thromboembolic cerebral infarction in patients with non-valvular atrial fibrillation (NVAF), who were treated with non-vitamin K antagonist oral anticoagulants (NOACs). Methods: The data of patients is collected from the database of our institute for about 3 years (between 2013 April and 2015 December). Results: We analyzed 16 patient’s data (14 male, 2 female, median age 67.0 years) in whom recurrent thromboembolic cerebral infarction occurred despite receiving NOACs. 14 of 16 patients with recurrent ischemic stroke received reduced dose drug, and in 10 of 14 patient with reduced dose drug, inappropriate dose setting (i.e., out of drug dose criteria of NOACs) has been selected by the physicians or practitioner concerning about the risk for intracranial hemorrhage and patient’s age. After we have changed to the appropriate dose, recurrence of thromboembolic cerebral infarction was not observed. More than 70 % of recurrent cerebral infarction occurred in patients with inappropriate underdose use of NOACs. Conclusions: This paper demonstrates that patients with inappropriate reduced dose selection of NOACs carry a significant risk of recurrent thromboembolic cerebral infarction despite treated with NOACs anticoagulation, highlighting the need for appropriate drug dose selection for stroke prevention in real-world NVAF patients.