Background: Use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in non-valvular atrial fibrillation (NVAF) is common and significantly reduces stroke occurrence. Yet little is known about patients who have a stroke despite treatment. Objective: The aim of this work was to study the epidemiology of patients with stroke despite being treated with NOACs. Methods: We identified a cohort of patients with NVAF admitted to the United Christian Hospital for acute ischemic stroke (AIS) or transient ischemic attack (TIA) while on NOACs. The baseline characteristics, type of NOAC, compliance, duration of use, and dosage were reviewed. Results: Of 2,090 patients admitted for AIS/TIA from 2012 to 2019, 143 were on NOACs before the index episode. After excluding patients with non-compliance and incomplete data, 109 patients were included in the analysis; 65.1% were female and 79.8% were never smokers, with a mean age of 78 years. The mean CHA2DS2-VASc score was 5; 83.5% had hypertension, 59.3% had hyperlipidemia, and 30.3% had diabetes mellitus. Overall, 52.9% presented with lacunar syndrome, suggesting an atherosclerotic cause of stroke. However, their risk factor control was unexpectedly good; none had HbA1c #x3e;7% and only 23.9% had a low-density lipoprotein cholesterol level higher than 2.6 mmol/L. Conclusions: Stroke developed in NVAF patients despite being on NOACs, with the majority being female, older, and hypertensive. Surprisingly, in general they had reasonable lipid and diabetic control.
Cerebrovasc Dis Extra 2021;11:9–14

中文翻译：

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非维生素K口服抗凝剂治疗房颤患者的残余卒中风险：一项为期8年的回顾性队列研究

背景：在非瓣膜性心房颤动（NVAF）中使用非维生素K拮抗剂口服抗凝剂（NOAC）预防中风是很普遍的，可显着减少中风的发生。关于尽管治疗但仍患有中风的患者知之甚少。目的：这项工作的目的是研究尽管接受过NOAC治疗的中风患者的流行病学。方法：我们确定了一批入选美国联合基督教医院因NVAC接受急性缺血性卒中（AIS）或短暂性脑缺血发作（TIA）的NVAF患者。回顾了基线特征，NOAC类型，依从性，使用时间和剂量。结果：在2012年至2019年接受AIS / TIA治疗的2,090位患者中，有143位在指数发作前接受过NOAC。在排除不合规和数据不完整的患者后，将109例患者纳入分析。女性为65.1％，从不吸烟者为79.8％，平均年龄为78岁。CHA2DS2-VASc平均得分是5；高血压患者占83.5％，高脂血症患者占59.3％，糖尿病患者占30.3％。总体而言，有52.9％的患者患有腔隙综合征，表明是中风的动脉粥样硬化原因。但是，他们的风险因素控制却出乎意料的好。没有人具有HbA1c＃x3e; 7％，只有23.9％的低密度脂蛋白胆固醇水平高于2.6 mmol / L。结论：尽管使用NOAC，但NVAF患者仍发生中风，大多数为女性，年龄较大和高血压。令人惊讶的是，它们总体上具有合理的脂质和糖尿病控制。
Cerebrovasc Dis Extra 2021; 11：9–14