Περίληψη:
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.
Συγγραφείς:
Cappellari, M.
Seiffge, D.J.
Koga, M.
Paciaroni, M.
Forlivesi, S.
Turcato, G.
Bovi, P.
Yoshimura, S.
Tanaka, K.
Shiozawa, M.
Yoshimoto, T.
Miwa, K.
Takagi, M.
Inoue, M.
Yamagami, H.
Caso, V.
Tsivgoulis, G.
Venti, M.
Acciarresi, M.
Alberti, A.
Toni, D.
Polymeris, A.
Bonetti, B.
Agnelli, G.
Toyoda, K.
Engelter, S.T.
Marchis, G.M.D.
on behalf of the SAMURAI-NVAF, RAF-NOAC, NOACISP LONG-TERM,
Verona Study Groups
Λέξεις-κλειδιά:
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
