Table 1.
Baseline characteristics.
| Overall cohort (n = 1,649) | Cancer (n = 247) | No cancer (n = 1,402) | SMD unweighted | SMD weighted | |
|---|---|---|---|---|---|
| Demographics | |||||
| Age (years), mean ± SD | 78.0 ± 10.7 | 79.4 ± 7.9 | 77.7 ± 10.9 | 0.263 | 0.168 |
| Sex—males, n (%) | 789 (47.8) | 129 (52.2) | 660 (47.1) | 0.103 | 0.024 |
| Ethnicity, n (%) | 0.437 | 0.395 | |||
| Non-Hispanic White | 1,303 (79.0) | 213 (86.2) | 1,090 (77.7) | ||
| Hispanic White | 113 (6.9) | 23 (9.3) | 90 (6.4) | ||
| Black | 24 (1.5) | 1 (0.4) | 23 (1.6) | ||
| Asian | 9 (0.5) | 1 (0.4) | 8 (0.6) | ||
| Other | 200 (12.1) | 9 (3.6) | 191 (13.6) | ||
| Baseline oral anticoagulation characteristics | |||||
| Type of oral anticoagulation at the time of index stroke, n (%) | 0.012 | 0.036 | |||
| VKA | 374 (22.7) | 55 (22.3) | 319 (22.8) | ||
| DOAC | 1,275 (77.3) | 192 (77.7) | 1,083 (77.2) | ||
| Type of DOAC at the time of index stroke, n (%) | 0.053 | 0.074 | |||
| Apixaban | 469/1,275 (36.8) | 71/192 (37.0) | 398/1,083 (36.7) | ||
| Rivaroxaban | 428/1,275 (33.6) | 57/192 (29.7) | 371/1,083 (34.3) | ||
| Edoxaban | 251/1,275 (19.7) | 43/192 (22.4) | 208/1,083 (19.2) | ||
| Dabigatran | 127/1,275 (10.0) | 21/192 (10.9) | 106/1,083 (9.8) | ||
| Time from last DOAC intake to admission, n (%) | 0.208 | 0.098 | |||
| < 12 hours | 653/1,275 (51.2) | 111/192 (57.8) | 542/1,083 (50.0) | ||
| 12-24 hours | 471/1,275 (36.9) | 68/192 (35.4) | 403/1,083 (37.2) | ||
| 24-48 hours | 151/1,275 (11.9) | 13/192 (6.8) | 138/1,083 (12.8) | ||
| INR on admission, mean ± SD | 1.39 ± 0.54 | 1.40 ± 0.56 | 1.37 ± 0.45 | 0.051 | 0.032 |
| INR on admission—patients on VKAs, n (%) | 0.030 | 0.080 | |||
| < 2 | 205/374 (54.8) | 29/55 (52.7) | 176/319 (55.2) | ||
| 2–3.5 | 156/374 (41.7) | 26/55 (47.3) | 130/319 (40.8) | ||
| > 3.5 | 13/374 (3.5) | 0/55 (0.0) | 13/319 (4.0) | ||
| DOAC levels on admission available, n (%) | 281/1,275 (22.0) | 53/192 (27.6) | 228/1,083 (21.1) | 0.153 | 0.081 |
| DOAC levels on admission, n (%) | |||||
| Below range | 67/281 (23.9) | 11/53 (20.8) | 56/228 (24.6) | 0.065 | 0.004 |
| Within range | 197/281 (70.1) | 39/53 (73.6) | 158/228 (69.3) | ||
| Above range | 17/281 (6.0) | 3/53 (5.6) | 14/228 (6.1) | ||
| Clinical characteristics | |||||
| Hospitalisation, n (%) | 1,596 (96.8) | 240 (97.2) | 1,356 (96.7) | 0.026 | 0.003 |
| Hospital setting, n (%) | 0.018 | 0.043 | |||
| Stroke unit | 1,504/1,596 (94.2) | 228/240 (95.0) | 1276/1,356 (94.1) | ||
| Intensive care unit | 42/1,596 (2.6) | 4/240 (1.7) | 38/13,563 (2.8) | ||
| Other hospital unit | 50/1,596 (3.1) | 8/240 (3.3) | 42/1,356 (3.1) | ||
| NIHSS on admission, median (IQR) | 11 (5–18) | 11 (5–18) | 10 (5–17) | 0.105 | 0.069 |
| Pre-stroke mRS score category, n (%) | 0.217 | 0.210 | |||
| No symptoms (score of 0), n (%) | 814 (49.4) | 105 (42.5) | 709 (50.6) | ||
| Symptoms without any disability (score of 1), n (%) | 369 (22.4) | 58 (23.5) | 311 (22.2) | ||
| Symptoms with mild disability (score of 2), n (%) | 223 (13.5) | 41 (16.6) | 182 (13.0) | ||
| Symptoms with mild-to-moderate disability (score of 3), n (%) | 179 (10.9) | 32 (14.2) | 144 (10.3) | ||
| Symptoms with moderate-to-severe disability (score of 4), n (%) | 59 (3.6) | 8 (3.2) | 51 (3.6) | ||
| Symptoms with severe disability (score of 5), n (%) | 5 (0.3) | 0 (0.0) | 5 (0.4) | ||
| Concomitant large-artery atherosclerosis, n (%)a | 240 (14.6) | 23 (9.3) | 217 (15.4) | 0.186 | 0.097 |
| Intravenous thrombolysis, n (%) | 139 (8.4) | 18 (7.3) | 121 (8.6) | 0.050 | 0.027 |
| Endovascular thrombectomy, n (%) | 732 (44.4) | 110 (44.5) | 622 (44.4) | 0.003 | 0.019 |
| Risk factors | |||||
| Arterial hypertension, n (%)b | 1,338 (81.1) | 200 (81.0) | 1,138 (81.2) | 0.003 | 0.026 |
| Dyslipidemia, n (%)c | 845 (51.2) | 120 (48.6) | 725 (51.7) | 0.063 | 0.062 |
| Diabetes, n (%)d | 443 (26.9) | 49 (19.8) | 394 (28.1) | 0.194 | 0.011 |
| Cigarette smoking, n (%)e | 154 (9.3) | 20 (8.1) | 134 (9.6) | 0.051 | 0.058 |
| Prior ischaemic stroke or TIA, n (%) | 410 (24.9) | 60 (24.3) | 350 (25.0) | 0.016 | 0.050 |
| Prior ICH, n (%) | 27 (1.6) | 6 (2.4) | 21 (1.5) | 0.067 | 0.067 |
| Ischaemic heart disease, n (%)f | 366 (22.2) | 57 (23.1) | 309 (22.0) | 0.025 | 0.088 |
| Chronic congestive heart failure, n (%)g | 277 (16.8) | 41 (16.6) | 236 (16.8) | 0.006 | 0.052 |
| Chronic kidney disease, n (%)h | 268 (16.3) | 48 (19.4) | 220 (15.7) | 0.098 | 0.018 |
| Chronic liver failure, n (%)i | 7 (0.4) | 1 (0.4) | 6 (0.4) | 0.004 | 0.001 |
| Symptomatic peripheral artery disease, n (%)j | 80 (4.9) | 16 (6.5) | 64 (4.6) | 0.084 | 0.024 |
| Mechanical heart valve, n (%) | 94 (5.7) | 15 (6.1) | 79 (5.6) | 0.019 | 0.031 |
| Biological heart valve, n (%) | 81 (4.9) | 19 (7.7) | 62 (4.4) | 0.137 | 0.006 |
| Atrial fibrillation type, n (%)k | 0.378 | 0.267 | |||
| Paroxysmal | 335 (20.3) | 53 (21.5) | 282 (20.1) | ||
| Persistent | 200 (12.1) | 9 (3.6) | 191 (13.6) | ||
| Long-standing persistent | 76 (4.6) | 9 (3.6) | 67 (4.8) | ||
| Permanent | 847 (51.4) | 148 (59.9) | 699 (49.9) | ||
| Unknown | 191 (11.6) | 28 (11.3) | 163 (11.6) | ||
| Antihypertensive drugs on admission, n (%) | 1,310 (79.4) | 194 (78.5) | 1,116 (79.6) | 0.026 | 0.092 |
| Lipid-lowering drugs on admission, n (%) | 742 (45.0) | 111 (44.9) | 631 (45.0) | 0.001 | 0.001 |
| Antidiabetic drugs on admission, n (%) | 397 (24.1) | 44 (17.8) | 353 (25.2) | 0.180 | 0.015 |
| Antiplatelet therapy on admission, n (%) | 131 (7.9) | 18 (7.3) | 113 (8.1) | 0.029 | 0.039 |
| Post-stroke secondary prevention | |||||
| Post-stroke anticoagulation strategy, n (%) | 0.164 | 0.128 | |||
| No anticoagulation restartedl | 179 (10.9) | 25 (10.1) | 179 (12.8) | ||
| Same DOAC restarted | 463 (28.1) | 62 (25.1) | 463 (33.0) | ||
| Switch to different DOAC within the FXa inhibitors class | 201 (12.2) | 23 (9.3) | 201 (14.3) | ||
| Switch to different DOAC (FXa inhibitors ↔ FIIa inhibitor) | 283 (17.2) | 42 (17.0) | 283 (27.2) | ||
| VKA → DOAC | 112 (6.8) | 18 (7.9) | 112 (8.0) | ||
| VKA → VKA | 179 (10.9) | 27 (7.3) | 179 (12.8) | ||
| DOAC → VKA | 59 (3.6) | 16 (5.3) | 59 (4.2) | ||
| DOAC → LMWH | 36 (2.2) | 11 (4.5) | 36 (2.6) | ||
| VKA → LMWH | 19 (1.2) | 3 (1.2) | 19 (1.6) | ||
| Left atrial appendage closure | 8 (0.5) | 0 (0.0) | 8 (0.6) | ||
| Unknown | 110 (6.7) | 20 (8.1) | 110 (7.8) | ||
| Days from index stroke to anticoagulation restart, mean ± SD | 8.1 ± 9.1 | 8.6 ± 9.9 | 8.0 ± 8.9 | 0.057 | 0.031 |
| Anticoagulation discontinued during follow-up, n (%) | 151/1,350 (11.2) | 30/201 (11.5) | 121/1,149 | 0.059 | 0.043 |
| Post-stroke antihypertensive drugs, n (%) | 1,346 (81.7) | 208 (84.2) | 1,138 (81.2) | 0.080 | 0.096 |
| Post-stroke lipid-lowering drugs, n (%) | 1,064 (64.5) | 161 (65.2) | 903 (64.4) | 0.007 | 0.018 |
| Post-stroke antidiabetic drugs, n (%) | 387 (23.5) | 43 (17.4) | 344 (24.5) | 0.195 | 0.037 |
| Post-stroke antiplatelet therapy, n (%) | 250 (15.2) | 38 (15.4) | 212 (15.2) | 0.001 | 0.018 |
aConcomitant large-artery atherosclerosis was classified according to the Trial of Org 10172 in the Acute Stroke Treatment (TOAST) classification system.
bHistory of blood pressure > 140/90 mmHg or the current use of antihypertensive medications.
cHistory of total blood cholesterol levels > 220 mg/dL and/or total triglycerides levels > 130 mg/dL and/or current used lipid-lowering drugs.
dHistory of fasting glucose > 126 mg/dL or the current use of hypoglycaemic medications.
eConsumption of ≥ 1 cigarette per day over the last year.
fIschaemic heart disease was defined as history of myocardial infarction, angina or prior evidence of coronary disease on coronary angiography.
gHistory of stage C (structural heart disease and current or past history of heart-failure symptoms) or stage D (refractory symptoms that interfere with daily life or recurrent hospitalisation despite targeted guideline-directed medical therapy) chronic heart failure.
hHistory of estimated creatinine clearance of less than 60 for 3 months or more (including dialysis).
iHistory of cirrhosis or end-stage liver disease.
jHistory of intermittent claudication of presumed atherosclerotic origin.
kClassified according to the ACC/AHA/HRS guidelines.
l121/179 (67.6%) died during the hospital stay; 16/179 patients (8.9%) had severe in-hospital bleeding events, mainly ICH (n = 11/16), 31/179 (17.3%), had no identifiable clinical reason for withholding oral anticoagulation after the index stroke. Weighted SMDs > 0.10 are reported in bold.
Abbreviations: DOAC = direct oral anticoagulant; INR = international normalised ratio; SMD = standardised mean difference; VKA = vitamin K antagonist.