{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:22:25Z","timestamp":1792686145878,"version":"4.5.0"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T00:00:00Z","timestamp":1602892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2021,1]]},"abstract":"Objective<\/jats:title>The aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin\u2009K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3\u2010month outcomes.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a cohort study of consecutive patients (2014\u20132019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT\/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0\u20132) at 3\u2009months.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2\u201311]) compared with VKA (6, [2\u201314]) and controls (7, [3\u201315], p<\/jats:italic>\u2009<\u20090.001; quantile regression: \u03b2 \u22122.1, 95% confidence interval [CI] \u22122.6 to \u22121.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50\u20130.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05\u20130.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6\u20134.7%) of controls, 9 of 195 (4.6%; 1.9\u20139.2%; aOR 0.93; 95% CI 0.46\u20131.90) patients on VKA and 2 of 65 (3.1%; 0.4\u201310.8%, aOR 0.56; 95% CI 0.28\u20131.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3\u2010month outcome (aOR 1.24; 1.01\u20131.51).<\/jats:p><\/jats:sec>Interpretation<\/jats:title>Prior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3\u2009months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2021;89:42\u201353<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.25917","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T08:43:58Z","timestamp":1601455438000},"page":"42-53","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":135,"title":["Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation"],"prefix":"10.1002","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0647-9273","authenticated-orcid":false,"given":"Thomas R.","family":"Meinel","sequence":"first","affiliation":[{"name":"Department of Neurology Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8063-7882","authenticated-orcid":false,"given":"Mattia","family":"Branca","sequence":"additional","affiliation":[{"name":"Clinicial Trials Unit Bern University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0342-9780","authenticated-orcid":false,"given":"Gian Marco","family":"De Marchis","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center University Hospital Basel and University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krassen","family":"Nedeltchev","sequence":"additional","affiliation":[{"name":"Department of Neurology Kantonsspital Aarau Aarau Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Kahles","sequence":"additional","affiliation":[{"name":"Department of Neurology Kantonsspital Aarau Aarau Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Bonati","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center University Hospital Basel and University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3594-2159","authenticated-orcid":false,"given":"Mirjam R.","family":"Heldner","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0045-5382","authenticated-orcid":false,"given":"Emmanuel","family":"Carrera","sequence":"additional","affiliation":[{"name":"Department of Neurology H\u00f4pitaux Universitaires de Gen\u00e8ve Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Dirren","sequence":"additional","affiliation":[{"name":"Department of Neurology H\u00f4pitaux Universitaires de Gen\u00e8ve Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Michel","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurology Service, Lausanne University Hospital Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Strambo","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurology Service, Lausanne University Hospital Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6479-1476","authenticated-orcid":false,"given":"Carlo W.","family":"Cereda","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurocenter of Southern Switzerland Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Bianco","sequence":"additional","affiliation":[{"name":"Stroke Center, Neurocenter of Southern Switzerland Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"K\u00e4gi","sequence":"additional","affiliation":[{"name":"Department of Neurology Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Vehoff","sequence":"additional","affiliation":[{"name":"Department of Neurology Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Katan","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Zurich Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Bolognese","sequence":"additional","affiliation":[{"name":"Neurocenter, Cantonal Hospital of Lucerne Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Backhaus","sequence":"additional","affiliation":[{"name":"Hirslanden Hospital Zurich Glattpark Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Salmen","sequence":"additional","affiliation":[{"name":"Spitalzentrum Biel Biel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvan","family":"Albert","sequence":"additional","affiliation":[{"name":"Cantonal Hospital Graubuenden Chur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Medlin","sequence":"additional","affiliation":[{"name":"Stroke Unit, Cantonal Hospital Fribourg Fribourg Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Berger","sequence":"additional","affiliation":[{"name":"Spital Sarganserland Grabs Grabs Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludwig","family":"Schelosky","sequence":"additional","affiliation":[{"name":"Neurology Cantonal Hospital M\u00fcnsterlingen M\u00fcnsterlingen Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Renaud","sequence":"additional","affiliation":[{"name":"Neurology Cantonal Hospital Neuchatel Neuch\u00e2tel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Niederhauser","sequence":"additional","affiliation":[{"name":"Stroke Unit Groupement hospitalier de l'ouest l\u00e9manique Nyon Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Bonvin","sequence":"additional","affiliation":[{"name":"H\u00f4pital du Valais Sion Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schaerer","sequence":"additional","affiliation":[{"name":"B\u00fcrgerspital Solothurn Solothurn Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie\u2010Luise","family":"Mono","sequence":"additional","affiliation":[{"name":"Stadtspital Waid und Triemli Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biljana","family":"Rodic","sequence":"additional","affiliation":[{"name":"Cantonal Hospital Winterthur Winterthur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Tarnutzer","sequence":"additional","affiliation":[{"name":"Cantonal hospital of Baden Baden Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Mordasini","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Gralla","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Kaesmacher","sequence":"additional","affiliation":[{"name":"Department of Neurology Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Engelter","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center University Hospital Basel and University of Basel Basel Switzerland"},{"name":"Neurology and Neurorehabilitation, University Department of Geriatic Medicine Felix Platter University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-3849","authenticated-orcid":false,"given":"David J.","family":"Seiffge","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital, Bern University Hospital, and University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Investigators of the Swiss Stroke Registry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62343-0"},{"key":"e_1_2_9_3_1","first-page":"CD009893","article-title":"Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non\u2010valvular atrial fibrillation","volume":"2014","author":"Salazar CA","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_4_1","first-page":"CD000187","article-title":"Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack","volume":"18","author":"Saxena R","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2017.05.358"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104584"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09412-y"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000343655"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.1371"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.023877"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022913"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.03.028"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.022606"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.023940"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23924"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2017.00395"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.012684"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.026606"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015484"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.026426"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/2396987318778971"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008362"},{"key":"e_1_2_9_23_1","first-page":"168","article-title":"Ein Werkzeug f\u00fcr die Qualit\u00e4tssicherung und Forschung","volume":"16","author":"Bonati L","year":"2016","journal-title":"Swiss Med Forum"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-016-1431-7"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000009155"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000009156"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13582"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1159\/000447952"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030138"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14171"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-9061-y"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-013-0560-7"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25165"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017206"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.07.021"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.014963"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.028327"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21456"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/000331970205300508"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13145"}],"container-title":["Annals of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.25917","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ana.25917","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.25917","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T20:05:45Z","timestamp":1693857945000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ana.25917"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,17]]},"references-count":39,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1002\/ana.25917"],"URL":"https:\/\/doi.org\/10.1002\/ana.25917","archive":["Portico"],"relation":{},"ISSN":["0364-5134","1531-8249"],"issn-type":[{"value":"0364-5134","type":"print"},{"value":"1531-8249","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,17]]},"assertion":[{"value":"2020-06-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}