Characteristics of Ischemic Versus Hemorrhagic Stroke in Patients Receiving Oral Anticoagulants: Results of the PASTA Study

Satoshi Suda; Arata Abe; Yasuyuki Iguchi; Yoshiki Yagita; Takao Kanzawa; Seiji Okubo; Nobuyuki Ohara; Takayuki Mizunari; Mineo Yamazaki; Nobuhito Nakajima; Kimito Kondo; Shigeru Fujimoto; Takeshi Inoue; Takeshi Iwanaga; Yuka Terasawa; Kensaku Shibazaki; Yu Kono; Makoto Nakajima; Masataka Nakajima; Masahiro Mishina; Koji Adachi; Ichiro Imafuku; Koichi Nomura; Takehiko Nagao; Hiroshi Yaguchi; Sadahisa Okamoto; Masato Osaki; Kazumi Kimura

doi:10.2169/internalmedicine.8113-21

ORIGINAL ARTICLES

Characteristics of Ischemic Versus Hemorrhagic Stroke in Patients Receiving Oral Anticoagulants: Results of the PASTA Study

Satoshi Suda, Arata Abe, Yasuyuki Iguchi, Yoshiki Yagita, Takao Kanzawa, Seiji Okubo, Nobuyuki Ohara, Takayuki Mizunari, Mineo Yamazaki, Nobuhito Nakajima, Kimito Kondo, Shigeru Fujimoto, Takeshi Inoue, Takeshi Iwanaga, Yuka Terasawa, Kensaku Shibazaki, Yu Kono, Makoto Nakajima, Masataka Nakajima, Masahiro Mishina, Koji Adachi, Ichiro Imafuku, Koichi Nomura, Takehiko Nagao, Hiroshi Yaguchi, Sadahisa Okamoto, Masato Osaki, Kazumi Kimura

Author information

Satoshi Suda
Department of Neurology, Nippon Medical School, Japan
Arata Abe
Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Japan
Yasuyuki Iguchi
Department of Neurology, The Jikei University School of Medicine, Japan
Yoshiki Yagita
Department of Stroke Medicine, Kawasaki Medical School, Japan
Takao Kanzawa
Department of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Japan
Seiji Okubo
Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Japan
Nobuyuki Ohara
Department of Neurology, Kobe City Medical Center General Hospital, Japan
Takayuki Mizunari
Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Japan
Mineo Yamazaki
Department of Neurology, Nippon Medical School Chiba Hokusoh Hospital, Japan
Nobuhito Nakajima
Department of Neurology, Kitamurayama Hospital, Japan
Kimito Kondo
Department of Neurology, Hokuto Hospital, Japan
Shigeru Fujimoto
Division of Neurology, Department of Medicine, Jichi Medical University Hospital, Japan
Takeshi Inoue
Department of Stroke Medicine, Kawasaki Medical School General Medical Center, Japan
Takeshi Iwanaga
Department of Stroke Medicine, Japanese Red Cross Okayama Hospital, Japan
Yuka Terasawa
Department of Neurology, Brain Attack Center Ota Memorial Hospital, Japan
Kensaku Shibazaki
Department of Stroke Medicine, Kurashiki Heisei Hospital, Japan
Yu Kono
Department of Neurology, Fuji City General Hospital, Japan
Makoto Nakajima
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
Masataka Nakajima
Department of Neurology, Heisei-Tateishi Hospital, Japan
Masahiro Mishina
Department of Neuro-pathophysiological Imaging, Graduate School of Medicine, Nippon Medical School, Japan
Koji Adachi
Department of Neurological Surgery, Nippon Medical School Musashi-Kosugi Hospital, Japan
Ichiro Imafuku
Department of Neurology, Yokohama Rosai Hospital, Japan
Koichi Nomura
Department of Neurology, Shioda Hospital, Japan
Takehiko Nagao
Department of Neurology, Nippon Medical School Tama Nagayama Hospital, Japan
Hiroshi Yaguchi
Department of Neurology, The Jikei University Kashiwa Hospital, Japan
Sadahisa Okamoto
Department of Neurology, Omuta Tenryo Hospital, Japan
Masato Osaki
Department of Cerebrovascular Medicine, Steel Memorial Yawata Hospital, Japan
Kazumi Kimura
Department of Neurology, Nippon Medical School, Japan

Keywords: atrial fibrillation, intracerebral hemorrhage, ischemic stroke, non-vitamin K antagonist oral anticoagulant, vitamin K antagonist

JOURNAL OPEN ACCESS

2022 Volume 61 Issue 6 Pages 801-810

DOI https://doi.org/10.2169/internalmedicine.8113-21

Browse “Advance online publication” version

Details

Abstract

Objective Limited data exist regarding the comparative detailed clinical characteristics of patients with ischemic stroke (IS)/transient ischemic attack (TIA) and intracerebral hemorrhage (ICH) receiving oral anticoagulants (OACs).

Methods The prospective analysis of stroke patients taking oral anticoagulants (PASTA) registry, a multicenter registry of 1,043 stroke patients receiving OACs [vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulant (NOACs)] across 25 medical institutions throughout Japan, was used. Univariate and multivariable analyses were used to analyze differences in clinical characteristics between IS/TIA and ICH patients with atrial fibrillation (AF) who were registered in the PASTA registry.

Results There was no significant differences in cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, smoking, or alcohol consumption (all p>0.05), between IS/TIA and ICH among both NOAC and VKA users. Cerebral microbleeds (CMBs) [odds ratio (OR), 4.77; p<0.0001] were independently associated with ICH, and high brain natriuretic peptide/N-terminal pro B-type natriuretic peptide levels (OR, 1.89; p=0.0390) were independently associated with IS/TIA among NOAC users. A history of ICH (OR, 13.59; p=0.0279) and the high prothrombin time-international normalized ratio (PT-INR) (OR, 1.17; p<0.0001) were independently associated with ICH, and a history of IS/TIA (OR, 3.37; 95% CI, 1.34-8.49; p=0.0101) and high D-dimer levels (OR, 2.47; 95% CI, 1.05-5.82; p=0.0377) were independently associated with IS/TIA among VKA users.

Conclusion The presence of CMBs, a history of stroke, natriuretic peptide and D-dimer levels, and PT-INR may be useful for risk stratification of either IS/TIA or ICH development in patients with AF receiving OACs.

Corresponding author

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