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Application of the "1-2-3-4-day" rule to stroke severity at baseline versus at 24 h to start direct oral anticoagulant for atrial fibrillation within 7 days from symptom onset.

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Title: Application of the "1-2-3-4-day" rule to stroke severity at baseline versus at 24 h to start direct oral anticoagulant for atrial fibrillation within 7 days from symptom onset.
Authors: Cappellari, Manuel (AUTHOR), Emiliani, Andrea (AUTHOR), Zivelonghi, Cecilia (AUTHOR), Micheletti, Nicola (AUTHOR), Tomelleri, Giampaolo (AUTHOR), Bonetti, Bruno (AUTHOR)
Source: Neurological Sciences. Aug2023, Vol. 44 Issue 8, p2821-2829. 9p. 4 Charts.
Subjects: Atrial fibrillation, Oral medication, Intracranial hemorrhage, Ischemic stroke, Anticoagulants, Dyslipidemia, Atrial flutter
Abstract: Introduction: The aim of this study is to compare the "1-2-3-4-day" rule applied to stroke severity at baseline versus at 24 h to start DOAC for AF within 7 days from symptom onset. Patients and methods: We conducted a prospective cohort observational study based on 433 consecutive AF-related stroke patients starting DOAC within 7 days from symptom onset. Four groups were identified according to the timing of DOAC introduction: 2-day, 3-day, 4-day, and 5–7-day. Results: Three models of multivariate ordinal regression including unbalanced variables among four groups (enrolment year, dyslipidemia, known AF, thrombolysis, thrombectomy, hemorrhagic transformation, DOAC type) were used to estimate the association of neurological severity categories (reference: NIHSS > 15) at baseline (Brant test: 0.818), at 24 h (Brant test: 0.997), and radiological severity categories (reference: major infarct) at 24 h (Brant test: 0.902) in the direction of earlier DOAC introduction on days (from 5–7-day to 2-day). Number of deaths was higher in early DOAC group than in late DOAC group according to the "1-2-3-4-day" rule (5.4% versus 1.3%, 6.8% versus 1.1%, and 4.2% versus 1.7% when it was applied to baseline neurological severity, 24-h neurological and radiological severity, respectively), but no significant difference was found and deaths were not caused by early DOAC introduction. Rates of ischemic stroke and intracranial hemorrhage were not different between early and late DOAC groups. Conclusions: The application of "1-2-3-4-day" rule to start DOAC for AF within 7 days from symptom onset differed when applied to baseline neurological stroke severity versus 24-h neurological and radiological severity, but safety and effecacy are similar. [ABSTRACT FROM AUTHOR]
Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Application of the "1-2-3-4-day" rule to stroke severity at baseline versus at 24 h to start direct oral anticoagulant for atrial fibrillation within 7 days from symptom onset.
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  Data: <searchLink fieldCode="AR" term="%22Cappellari%2C+Manuel%22">Cappellari, Manuel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Emiliani%2C+Andrea%22">Emiliani, Andrea</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zivelonghi%2C+Cecilia%22">Zivelonghi, Cecilia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Micheletti%2C+Nicola%22">Micheletti, Nicola</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tomelleri%2C+Giampaolo%22">Tomelleri, Giampaolo</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bonetti%2C+Bruno%22">Bonetti, Bruno</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Neurological+Sciences%22">Neurological Sciences</searchLink>. Aug2023, Vol. 44 Issue 8, p2821-2829. 9p. 4 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Atrial+fibrillation%22">Atrial fibrillation</searchLink><br /><searchLink fieldCode="DE" term="%22Oral+medication%22">Oral medication</searchLink><br /><searchLink fieldCode="DE" term="%22Intracranial+hemorrhage%22">Intracranial hemorrhage</searchLink><br /><searchLink fieldCode="DE" term="%22Ischemic+stroke%22">Ischemic stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Anticoagulants%22">Anticoagulants</searchLink><br /><searchLink fieldCode="DE" term="%22Dyslipidemia%22">Dyslipidemia</searchLink><br /><searchLink fieldCode="DE" term="%22Atrial+flutter%22">Atrial flutter</searchLink>
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  Data: Introduction: The aim of this study is to compare the "1-2-3-4-day" rule applied to stroke severity at baseline versus at 24 h to start DOAC for AF within 7 days from symptom onset. Patients and methods: We conducted a prospective cohort observational study based on 433 consecutive AF-related stroke patients starting DOAC within 7 days from symptom onset. Four groups were identified according to the timing of DOAC introduction: 2-day, 3-day, 4-day, and 5–7-day. Results: Three models of multivariate ordinal regression including unbalanced variables among four groups (enrolment year, dyslipidemia, known AF, thrombolysis, thrombectomy, hemorrhagic transformation, DOAC type) were used to estimate the association of neurological severity categories (reference: NIHSS > 15) at baseline (Brant test: 0.818), at 24 h (Brant test: 0.997), and radiological severity categories (reference: major infarct) at 24 h (Brant test: 0.902) in the direction of earlier DOAC introduction on days (from 5–7-day to 2-day). Number of deaths was higher in early DOAC group than in late DOAC group according to the "1-2-3-4-day" rule (5.4% versus 1.3%, 6.8% versus 1.1%, and 4.2% versus 1.7% when it was applied to baseline neurological severity, 24-h neurological and radiological severity, respectively), but no significant difference was found and deaths were not caused by early DOAC introduction. Rates of ischemic stroke and intracranial hemorrhage were not different between early and late DOAC groups. Conclusions: The application of "1-2-3-4-day" rule to start DOAC for AF within 7 days from symptom onset differed when applied to baseline neurological stroke severity versus 24-h neurological and radiological severity, but safety and effecacy are similar. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1007/s10072-023-06717-9
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      – SubjectFull: Atrial fibrillation
        Type: general
      – SubjectFull: Oral medication
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      – SubjectFull: Intracranial hemorrhage
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              Text: Aug2023
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