|
DOAC pretreatment (N=75)
|
VKA pretreatment (N=61)
|
P
|
Confirmed therapeutic DOAC (N=35)
|
Confirmed therapeutic VKA (N=45)
|
P
|
Clinical items
|
|
|
|
|
|
|
Age (years)
|
76 (67 – 82)
|
81 (75 – 84)
|
0.010
|
76 (68 – 83)
|
80 (74 – 84)
|
0.117
|
Body mass index (kg/m2)
|
26.4 (22.9 – 29.4)
|
25.8 (23.6 – 28.6)
|
0.674
|
27.0 (23.1 – 30.0)
|
25.7 (23.7 – 29.3)
|
0.376
|
Sex (female)
|
27/75 (36.0%)
|
26/61 (42.6%)
|
0.482
|
13/35 (37.1%)
|
20/45 (44.4%)
|
0.648
|
Preevent modified Rankin Scale
|
0.5 (0 – 1)
|
1 (0 – 2)
|
0.306
|
0 (0 – 1)
|
1 (0 – 2)
|
0.327
|
Onset
- Known
- Wake-up
- Unknown
|
34/75 (45.3%) 14/75 (18.7%)
27/75 (36.0%)
|
36/61 (59.0%) 7/61 (11.5%) 18/61 (29.5%)
|
0.398
|
18/35 (51.4%)
6/35 (17.1%)
11/35 (31.4%)
|
29/45 (64.4%)
4/45 (8.9%)
12/45 (26.7%)
|
0.407
|
1st blood pressure, systolic
|
160 (136 – 176)
|
160 (146 – 182)
|
0.318
|
156 (135 – 178)
|
159 (143 – 176)
|
0.446
|
1st blood pressure, diastolic
|
79 (70 – 94)
|
88 (73 – 100)
|
0.089
|
78 (69 – 92)
|
87 (72 – 99)
|
0.145
|
1st Glucose (mmol/L)
|
6.2 (5.5 – 7.4)
|
6.5 (5.5 – 7.9)
|
0.500
|
6.3 (5.7 – 7.7)
|
6.6 (5.6 – 7.9)
|
0.773
|
1st Cholesterol, total (mmol/L)
|
4.4 (3.8 – 5.1)
|
4.5 (4.0 – 5.3)
|
0.244
|
4.5 (3.8 – 5.3)
|
4.5 (3.8 – 5.2)
|
0.848
|
1st Cholesterol, LDL (mmol/L)
|
2.4 (1.9 – 3.2)
|
2.4 (2.0 – 3.3)
|
0.570
|
2.4 (1.9 – 3.3)
|
2.4 (2.1 – 3.4)
|
0.587
|
1st Creatinine (umol/L)
|
87 (75 – 102)
|
88 (72 – 105)
|
0.666
|
89 (75 – 101)
|
86 (70 – 107)
|
0.809
|
NIHSS on admission
|
3 (2 – 8)
|
5 (1 – 10)
|
0.697
|
4.5 (2 – 8.5)
|
5 (1 – 12)
|
0.996
|
Medication
|
|
|
|
|
|
|
Additional Antiplatelet
|
11/75 (14.7%)
|
11/61 (18.3%)
|
0.642
|
3/35 (8.6%)
|
9/45 (20%)
|
0.210
|
Lipid lowering drug
|
31/75 (41.3%)
|
26/61 (42.6%)
|
0.661
|
16/35 (45.7%)
|
22/45 (48.9%)
|
0.824
|
Anticoagulation
- Confirmed therapeutic
- Uncertain
- Confirmed non-therapeutic
|
35/75 (46.7%) 30/75 (40%) 10/75 (13.3%)
|
45/61 (73.8%)
0
16/61 (26.2%)
|
|
|
|
|
Risk factors
|
|
|
|
|
|
|
Previous stroke
|
22/75 (29.3%)
|
14/61 (23.0%)
|
0.626
|
11/35 (31.4%)
|
9/45 (20%)
|
0.239
|
Previous transient ischemic attack
|
8/75 (10.7%)
|
7/61 (11.5%)
|
0.913
|
6/35 (17.1%)
|
6/45 (13.3%)
|
0.454
|
Arterial Hypertension
|
62/75 (82.7%)
|
53/61 (86.9%)
|
0.690
|
28/35 (90%)
|
40/45 (88.9%)
|
0.370
|
Diabetes
|
15/75 (20.0%)
|
13/61 (21.3%)
|
0.957
|
7/35 (20%)
|
9/45 (20%)
|
0.984
|
Hyperlipidemia
|
46/75 (61.3%)
|
41/61 (67.2%)
|
0.623
|
19/35 (54.3%)
|
30/45 (66.7%)
|
0.192
|
Smoking
|
15/75 (20.0%)
|
4/61 (6.6%)
|
0.073
|
7/35 (20%)
|
2/45 (4.4%)
|
0.076
|
Heart failure
|
11/75 (14.7%)
|
15/61 (24.6%)
|
0.328
|
5/35 (14.3%)
|
11/45 (24.4%)
|
0.296
|
Mechanical Heart Valve
|
0
|
4/61 (6.6%)
|
0.098
|
0
|
3/45 (6.7%)
|
0.135
|
Low Ejection Fraction (<30%)
|
2/75 (2.7%)
|
1/61 (1.6%)
|
0.657
|
1/35 (2.9%)
|
0
|
0.437
|
Peripheral artery disease
|
8/75 (10.7%)
|
4/61 (6.6%)
|
0.677
|
3/35 (8.6%)
|
4/45 (8.9%)
|
0.983
|
Treatment
|
|
|
|
|
|
|
Acute recanalization therapy
- Intravenous thrombolysis
- Endovascular thrombectomy
- Intraarterial thrombolysis
|
2/75 (2.7%)
10/75 (13.3%)
1/75 (1.3%)
|
1/61 (1.6%)
10/61 (16.4%)
1/61 (1.6%)
|
0.905
|
1/35 (2.9%)
3/35 (8.6%)
0
|
0
6/45 (13.3%)
1/45 (2.2%)
|
0.464
|
Imaging
|
|
|
|
|
|
|
Fazekas Score
|
1 (0 – 2)
|
2 (1 – 3)
|
<0.001
|
1 (0 – 2)
|
2 (1 – 3)
|
0.014
|
Cerebral Microbleeds present
|
28/72 (38.9%)
|
27/57 (47.4%)
|
0.373
|
16/33 (48.5%)
|
22/42 (52.4%)
|
0.818
|
Table 1 – Baseline characteristics comparing patients with DOAC and VKA pretreatment.
DOAC: direct oral anticoagulant, VKA: vitamin K antagonist, NIHSS: National Institute of Health Stroke Scale
|
DOAC pretreatment (N=75)
|
VKA pretreatment (N=61)
|
P
|
Confirmed therapeutic DOAC (N=35)
|
Confirmed therapeutic VKA (N=45)
|
P
|
Any large vessel occlusion
- Proximal ICA
- Carotid-T
- Proximal M1
- Distal M1
- M2
- M3
- A1
- A2
- V4
- BA
- P1
- P2/3
- Multiple
- SCA
|
22/75 (29.3%)
1 (4.5%)
2 (9.1%)
7 (31.8%)
3 (13.6%)
6 (27.3%)
0
0
1 (4.5%)
0
0
0
1 (4.5%)
1 (4.5%)
0
|
23/61 (37.7%)
1 (4.3%)
2 (8.7%)
4 (17.4%)
1 (4.3%)
6 (26.1%)
1 (4.3%)
0
0
1 (4.3%)
0
1 (4.3%)
4 (17.4%)
1 (4.3%)
1 (4.3%)
|
0.361
|
9/35 (25.7%)
0
1 (11.1%)
3 (33.3%)
1 (11.1%)
3 (33.3%)
0
0
0
0
0
0
0
1 (11.1%)
0
|
14/45 (31.1%)
0
1 (7.1%)
1 (7.1%)
1 (7.1%)
4 (28.6%)
1 (7.1%)
0
0
1 (7.1%)
0
1 (7.1%)
4 (28.6%)
0
0
|
0.628
|
Potential target large vessel occlusion for EVT
|
20/75 (26.7%)
|
17/61 (27.9%)
|
1.000
|
9/35 (25.7%)
|
9/45 (20.0%)
|
0.596
|
Table 2 – Patterns of Large Vessel Occlusions comparing patients with DOAC and VKA pretreatment.
DOAC: direct oral anticoagulant, VKA: vitamin K antagonist, ICA: internal carotid artery, M1: M1-segment of medial cerebral artery, M2: M2-segment of medial cerebral artery, M3: M3-segment of medial cerebral artery, A1: A1-segment of anterior cerebral artery, A2: A2-segment of anterior cerebral artery, V4: V4-segment of vertebral artery, BA: basilar artery, P1: P1-segment of posterior cerebral artery, P2/3: P2 or P3-segment of posterior cerebral artery, SCA: Superior cerebellar artery, EVT: endovascular stroke treatment.
|
DOAC pretreatment (N=75)
|
VKA pretreatment (N=61)
|
P
|
Confirmed therapeutic DOAC (N=35)
|
Confirmed therapeutic VKA (N=45)
|
P
|
Clinical outcome
|
|
|
|
|
|
|
NIHSS at 24 hours
|
2 (1 – 4)
|
3 (0 – 7)
|
0.359
|
3 (1 – 5)
|
4 (0 – 8)
|
0.565
|
sICH ECASS-II
|
1/75 (1.3%)
|
1/61 (1.6%)
|
0.735
|
0
|
1/45 (2.2%)
|
0.298
|
Duration of hospital stay, days
|
4 (2 – 8)
|
4 (2 – 8)
|
0.345
|
4 (3 – 7)
|
4 (2 – 8)
|
0.359
|
90d mRS
|
1.5 (1 – 3)
|
3 (1.5 – 4)
|
0.001
|
1 (1 – 2)
|
3 (2 – 6)
|
<0.001
|
90d recurrent stroke
|
2/75 (2.7%)
|
4/61 (6.6%)
|
0.255
|
0
|
3/45 (6.7%)
|
0.185
|
Imaging
|
|
|
|
|
|
|
Diameter axis 1, initial DWI, mm
|
18 (11 – 36)
|
20 (7 – 36)
|
0.607
|
19 (12 – 33)
|
13 (6 – 26)
|
0.111
|
Diameter axis 2, initial DWI, mm
|
10 (6 – 19)
|
9 (5 – 23)
|
0.780
|
12 (6 – 19)
|
7 (4 – 16)
|
0.127
|
Diameter hypoperfusion axis 1, mm
|
80 (38 – 118), N=40
|
49 (36 – 67), N=37
|
0.039
|
83 (27 – 118), N=16
|
49 (36 – 66), N=13
|
0.079
|
Diameter hypoperfusion axis 2, mm
|
34 (18 – 40), N=40
|
34 (14 – 40), N=37
|
0.494
|
34 (20 – 46), N=16
|
33 (13 – 38), N=13
|
0.318
|
DWI/Perfusion Mismatch
- None
- Small
- Medium
- Large
|
39/66 (59.1%) 4/66 (6.1%) 4/66 (6.1%) 19/66 (28.8%)
|
29/53 (54.7%) 8/53 (15.1%) 3/53 (5.7%) 13/53 (24.5%)
|
0.443
|
17/28 (60.7%) 1/28 (3.6%)
2/28 (7.1%) 8/28 (28.6%)
|
26/40 (65.0%) 3/40 (7.5%)
1/40 (2.5%)
10/40 (25%)
|
0.714
|
Diameter axis 1, final FLAIR
|
18 (12 – 38)
|
27 (8 – 50)
|
0.409
|
18 (13 – 23)
|
20 (6 – 52)
|
0.945
|
Diameter axis 2, final FLAIR
|
10 (6 – 22)
|
14 (7 – 25)
|
0.397
|
10 (6 – 22)
|
11 (5 – 25)
|
0.908
|
Occlusion, any
|
22/75 (29.3%)
|
23/61 (37.7%)
|
0.361
|
9/35 (25.7%)
|
14/45 (31.1%)
|
0.628
|
Target occlusion for EVT
|
20/75 (26.7%)
|
17/61 (27.9%)
|
1.000
|
9/35 (25.7%)
|
9/45 (20.0%)
|
0.596
|
Thrombus length
|
8 (6 – 20), N=19
|
13 (7 – 24), N=13
|
0.388
|
15 (6 – 21), N=7
|
11 (4 – 30), N=6
|
0.836
|
Multiple Lesions
|
31/56 (55.4%)
|
24/49 (49.0%)
|
0.560
|
10/21 (47.6%)
|
20/41 (48.8%)
|
1.000
|
ICH, Heidelberg at follow up
- 1a
- 1b
- 2
- 3c
|
5/75 (6.7%) 0
0
1/75 (1.3%)
|
3/61 (4.9%) 7/61 (11.5%) 1/61 (1.6%) 0
|
0.024
|
4/35 (11.4%) 0
0
1 (2.9%)
|
3/45 (6.7%) 5/45 (11.1%) 0
0
|
0.126
|
Table 3 – Outcome parameter comparing patients with DOAC and VKA pretreatment.
DOAC: direct oral anticoagulant, VKA: vitamin K antagonist, NIHSS: National Institute of Health Stroke Scale; sICH ECASS II: symptomatic intracranial hemorrhage according to the European Co-operative Acute Stroke Study-II definition, mRS: modified Rankin Scale; DWI: diffusion weighted imaging; FLAIR: fluid attenuated inversion recovery sequence; EVT: endovascular stroke treatment; ICH: intracranial hemorrhage