@article{3103461,
    title = "A nomogram to predict unfavourable outcome in patients receiving oral anticoagulants for atrial fibrillation after stroke",
    author = "Cappellari, M. and Seiffge, D.J. and Koga, M. and Paciaroni, M. and Forlivesi, S. and Turcato, G. and Bovi, P. and Yoshimura, S. and Tanaka, K. and Shiozawa, M. and Yoshimoto, T. and Miwa, K. and Takagi, M. and Inoue, M. and Yamagami, H. and Caso, V. and Tsivgoulis, G. and Venti, M. and Acciarresi, M. and Alberti, A. and Toni, D. and Polymeris, A. and Bonetti, B. and Agnelli, G. and Toyoda, K. and Engelter, S.T. and Marchis, G.M.D. and on behalf of the SAMURAI-NVAF, RAF-NOAC, NOACISP LONG-TERM, and Verona Study Groups",
    journal = "European Stroke Journal",
    year = "2020",
    volume = "5",
    number = "4",
    pages = "384-393",
    publisher = "SAGE Publications Ltd",
    issn = "2396-9873, 2396-9881",
    doi = "10.1177/2396987320945840",
    keywords = "anticoagulant agent;  antivitamin K;  apixaban;  dabigatran;  edoxaban;  rivaroxaban, aged;  all cause mortality;  Article;  atrial fibrillation;  blood clot lysis;  brain hemorrhage;  brain ischemia;  cerebrovascular disease;  CHA2DS2-VASc score;  clinical outcome;  cohort analysis;  computer assisted tomography;  creatinine clearance;  disease severity;  female;  HAS BLED score;  human;  hyperlipidemia;  hypertension;  major clinical study;  male;  multicenter study;  National Institutes of Health Stroke Scale;  neurologic disease;  nomogram;  nuclear magnetic resonance imaging;  outcome assessment;  priority journal;  prospective study;  Rankin scale;  receiver operating characteristic;  recurrent disease;  revascularization;  smoking;  transient ischemic attack",
    abstract = "Introduction: It is unknown whether the type of treatment (direct oral anticoagulant versus vitamin K antagonist) and the time of treatment introduction (early versus late) may affect the functional outcome in stroke patients with atrial fibrillation. We aimed to develop and validate a nomogram model including direct oral anticoagulant/vitamin K antagonist and early/late oral anticoagulant introduction for predicting the probability of unfavourable outcome after stroke in atrial fibrillation-patients. Patients and Methods: We conducted an individual patient data analysis of four prospective studies. Unfavourable functional outcome was defined as three-month modified Rankin Scale score 3 -6. To generate the nomogram, five independent predictors including age (<65 years, reference; 65--79; or 80), National Institutes of Health Stroke Scale score (0--5 points, reference; 6--15; 16--25; or >25), acute revascularisation treatments (yes, reference, or no), direct oral anticoagulant (reference) or vitamin K antagonist, and early (7 days, reference) or late (8--30) anticoagulant introduction entered into a final logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve. Results: A total of 2102 patients with complete data for generating the nomogram was randomly dichotomised into training (n = 1553) and test (n = 549) sets. The area under the receiver operating characteristic curve was 0.822 (95% confidence interval, CI: 0.800--0.844) in the training set and 0.803 (95% CI: 0.764--0.842) in the test set. The model was adequately calibrated (9.852; p = 0.276 for the Hosmer--Lemeshow test). Discussion and Conclusion: Our nomogram is the first model including type of oral anticoagulant and time of treatment introduction to predict the probability of three-month unfavourable outcome in a large multicentre cohort of stroke patients with atrial fibrillation. © European Stroke Organisation 2020."
}