The Introduction Timing of Oral Anticoagulants in the Early Phase of Acute Stroke Patients

Objective: This study was aimed to reveal the possibility of newly emerged hemorrhagic complication in acute ischemic stroke patients after the introduction of oral anticoagulants, including warfarin and direct oral anticoagulants (DOACs). Methods: Acute ischemic stroke patients who admitted to the hospital within 24 hrs following onset were consecutively screened between July 2012 and June 2013. Then, patients with oral anticoagulant as secondary stroke prevention introduced within 2 weeks were enrolled in this study (n=95). The hemorrhagic complication following the institution of anticoagulants was assessed by repeated brain CT or MRI. Results: Warfarin was prescribed to 34patients and DOACs were prescribed to 61patients (dabigatran 27and rivaroxaban 34). Patients with DOACs showed significantly milder deficits compared with warfarin (p<0.01: NIH Stroke Scale 5.5and 10.3, respectively). Regarding the newly emerged hemorrhagic complication following the institution of anticoagulants, its frequency was not significantly different between warfarin and DOACs (16.1% and 23.9%, respectively). The hemorrhagic complication was not observed, if anticoagulation was started later than4, 5and 6 days following onset in the small, moderate and large infarctions, respectively. No recurrent ischemic stroke was observed during the observation period. Conclusion: Not only warfarin but also DOACs could be safely started from the acute phase of stroke depending on the lesion size in the real clinical world. Further study might need to confirm our findings.