TY - JOUR
TI - A nomogram to predict unfavourable outcome in patients receiving oral anticoagulants for atrial fibrillation after stroke
AU - Cappellari, M.
AU - Seiffge, D.J.
AU - Koga, M.
AU - Paciaroni, M.
AU - Forlivesi, S.
AU - Turcato, G.
AU - Bovi, P.
AU - Yoshimura, S.
AU - Tanaka, K.
AU - Shiozawa, M.
AU - Yoshimoto, T.
AU - Miwa, K.
AU - Takagi, M.
AU - Inoue, M.
AU - Yamagami, H.
AU - Caso, V.
AU - Tsivgoulis, G.
AU - Venti, M.
AU - Acciarresi, M.
AU - Alberti, A.
AU - Toni, D.
AU - Polymeris, A.
AU - Bonetti, B.
AU - Agnelli, G.
AU - Toyoda, K.
AU - Engelter, S.T.
AU - Marchis, G.M.D.
AU - on behalf of the SAMURAI-NVAF, RAF-NOAC, NOACISP LONG-TERM,
AU - Verona Study Groups
JO - European Stroke Journal
PY - 2020
VL - 5
TODO - 4
SP - 384-393
PB - SAGE Publications Ltd
SN - 2396-9873, 2396-9881
TODO - 10.1177/2396987320945840
TODO - 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
TODO - 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.
ER -