Table 3. Outcomes of Patients With Acute Ischemic Stroke Treated With Intravenous Alteplase by Anticoagulant Therapy Status Prior to Stroke.
| Taking NOACs (n = 2207) |
Not taking anticoagulants (n = 160 831) |
Odds ratio (95% CI) | Adjusted absolute risk difference, % (95% CI)a | ||
|---|---|---|---|---|---|
| Unadjusted | Adjusteda | ||||
| Primary outcome | |||||
| Symptomatic intracranial hemorrhage within 36 h, No. (%) | 81 (3.7) | 5129 (3.2) | 1.18 (0.94 to 1.47) | 0.88 (0.70 to 1.10) | −0.51 (−1.36 to 0.34) |
| Secondary outcomes | |||||
| Life-threatening or serious systemic hemorrhage within 36 h, No. (%) | 16 (0.7) | 898 (0.6) | 1.28 (0.79 to 2.07) | 0.95 (0.57 to 1.60) | −0.03 (−0.39 to 0.32) |
| Any alteplase complication, No. (%)b | 152 (6.9) | 9728 (6.0) | 1.15 (0.97 to 1.37) | 0.87 (0.73 to 1.04) | −0.94 (−2.09 to 0.21) |
| Inpatient mortality, No. (%) | 139 (6.3) | 7925 (4.9) | 1.28 (1.05 to 1.56) | 0.84 (0.69 to 1.01) | −1.20 (−2.39 to −0) |
| In-hospital mortality or discharged to hospice, No. (%) | 273 (12.4) | 15 109 (9.4) | 1.35 (1.16 to 1.56) | 0.87 (0.76 to 1.00) | −1.63 (−3.20 to −0.06) |
| Able to ambulate independently at hospital discharge, No./total (%) | 1008/1951 (51.7) | 83 807/144 751 (57.9) | 0.81 (0.74 to 0.88) | 1.25 (1.12 to 1.40) | 5.65 (2.91 to 8.40) |
| Free of disabilities (modified Rankin Scale score of 0-1 at hospital discharge), No./total (%)c | 372/1382 (26.9) | 34 548/101 554 (34.0) | 0.74 (0.65 to 0.83) | 1.22 (1.06 to 1.42) | 3.71 (0.91 to 6.52) |
| Functionally independent (modified Rankin Scale score of 0-2 at hospital discharge), No./total (%)c | 513/1382 (37.1) | 45 212/101 554 (44.5) | 0.76 (0.68 to 0.85) | 1.27 (1.11 to 1.45) | 5.28 (2.15 to 8.41) |
| Discharge location, No./total (%) | |||||
| Home | 1014/2207 (45.9) | 86 171/160 831 (53.6) | 0.75 (0.69 to 0.82) | 1.17 (1.06 to 1.29) | 3.84 (1.46 to 6.22) |
| Hospice | 135/2207 (6.1) | 7288/160 831 (4.5) | 1.36 (1.12 to 1.65) | 0.91 (0.76 to 1.10) | −0.57 (−1.71 to 0.56) |
| Inpatient rehabilitation facility | 490/2179 (22.5) | 34 110/158 499 (21.5) | 1.06 (0.95 to 1.17) | 1.01 (0.90 to 1.14) | 0.20 (−1.82 to 2.22) |
| Skilled nursing facility | 403/2179 (18.5) | 23 228/158 499 (14.7) | 1.31 (1.17 to 1.47) | 0.90 (0.80 to 1.02) | −1.59 (−3.51 to 0.33) |
| Hospital length of stay >4 d, No./total (%) | 1032/2194 (47.0) | 62103/160 183 (38.8) | 1.30 (1.19 to 1.43) | 0.93 (0.84 to 1.03) | −1.73 (−4.22 to 0.76) |
Abbreviation: NOACs, non–vitamin K antagonist oral anticoagulants.
Adjusted for potential confounders including age, sex, race and ethnicity, medical history of atrial fibrillation or flutter, coronary artery disease or prior myocardial infarction, hypertension, dyslipidemia, diabetes, smoking, heart failure, prosthetic heart valve, previous stroke, previous transient ischemic attack, carotid stenosis, peripheral vascular disease, chronic kidney disease, medications prior to hospital admission (including antiplatelets, antihypertensives, cholesterol reducers, and any diabetes), systolic blood pressure, blood glucose level, initial National Institutes of Health Stroke Scale score, last known time of being well to alteplase initiation, receipt of endovascular therapy, insurance status, arrival by emergency medical services, arrival time during regular working hours (7 am-6 pm Monday-Friday), and hospital-level variables (including stroke center status, academic status, annual ischemic stroke volume, annual thrombolytic volume, number of beds, geographic region, and rural or urban location). Additional details appear in the eMethods in the Supplement.
Includes symptomatic intracranial hemorrhage within 36 hours, life-threatening or serious systemic hemorrhage within 36 hours, or other serious complications (those that required additional medical interventions or prolonged length of stay).
The modified Rankin Scale has a score range of 0 to 6 with 0 being no symptoms; 1, no significant disability; 2, slight disability; 3, moderate disability; 4, moderately severe disability; 5, severe disability; and 6, death.