Introduction of direct oral anticoagulant within 7 days of stroke onset: a nomogram to predict the probability of 3-month modified Rankin Scale score > 2

Manuel Cappellari, Gianni Turcato, Stefano Forlivesi, Nicola Micheletti, Giampaolo Tomelleri, Bruno Bonetti, Giovanni Merlino, Roberto Eleopra, Monia Russo, Roberto L’Erario, Alessandro Adami, Carolina Gentile, Anna Gaudenzi, Sandro Bruno, Paolo Bovi

Research output: Contribution to journalArticle

Abstract

In clinical practice, direct oral anticoagulants (DOACs) are often started earlier (≤ 7 days) than in randomized clinical trials after stroke. We aimed to develop a nomogram model incorporating time of DOAC introduction ≤ 7 days of stroke onset in combination with different degrees of stroke radiological/neurological severity at the time of treatment to predict the probability of unfavorable outcome. We conducted a multicenter prospective study including 344 patients who started DOAC 1–7 days after atrial fibrillation-related stroke onset. Computed tomography scan 24–36 h after stroke onset was performed in all patients before starting DOAC. Unfavorable outcome was defined as modified Rankin Scale (mRS) score > 2 at 3 months. Based on multivariate logistic model, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve (AUC–ROC) and calibration of risk prediction model by using the Hosmer–Lemeshow test. Onset-to-treatment time for DOAC (OR: 1.21, p = 0.030), NIH Stroke Scale (NIHSS) score at the time of treatment (OR: 1.00 for NIHSS = 0–5; OR: 2.67, p = 0.016 for NIHSS = 6–9; OR: 26.70, p < 0.001 for NIHSS = 10–14; OR: 57.48, p < 0.001 for NIHSS ≥ 15), size infarct (OR: 1.00 for small infarct; OR: 2.26, p = 0.023 for medium infarct; OR: 3.40, p = 0.005 for large infarct), and age ≥ 80 years (OR: 1.96, p = 0.028) remained independent predictors of unfavorable outcome to compose the nomogram. The AUC–ROC of nomogram was 0.858. Calibration was good (p = 2.889 for the Hosmer–Lemeshow test). The combination of onset-to-treatment time of DOAC with stroke radiological/neurological severity at the time of treatment and old age may predict the probability of unfavorable outcome.

Original languageEnglish
Pages (from-to)292-298
Number of pages7
JournalJournal of Thrombosis and Thrombolysis
Volume46
Issue number3
DOIs
Publication statusPublished - Oct 1 2018

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Keywords

  • Atrial fibrillation
  • Direct oral anticoagulants
  • Nomogram
  • Outcome
  • Stroke

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Cappellari, M., Turcato, G., Forlivesi, S., Micheletti, N., Tomelleri, G., Bonetti, B., Merlino, G., Eleopra, R., Russo, M., L’Erario, R., Adami, A., Gentile, C., Gaudenzi, A., Bruno, S., & Bovi, P. (2018). Introduction of direct oral anticoagulant within 7 days of stroke onset: a nomogram to predict the probability of 3-month modified Rankin Scale score > 2. Journal of Thrombosis and Thrombolysis, 46(3), 292-298. https://doi.org/10.1007/s11239-018-1700-8