Patient characteristics stratified to stroke aetiology
| Characteristic | All (N=2946) | N missing | Aetiology of stroke despite anticoagulation | |||
| Competing mechanism (N=713) | Insufficient anticoagulation (N=934) | Cardioembolism despite sufficient anticoagulation (N=1299) | P value | |||
| Demographics | ||||||
| Age, median (IQR), years | 81 (76–86) | 0 | 80 (74–85.1) | 82.45 (77–86.9) | 81 (75–86) | <0.001 |
| Female sex, N (%) | 1404 (47.7) | 0 | 254 (35.6) | 533 (57.1) | 617 (47.5) | <0.001 |
| Risk factors | ||||||
| Hypertension, N (%) | 2649 (89.9) | 0 | 632 (88.6) | 844 (90.4) | 1173 (90.3) | 0.430 |
| Diabetes, N (%) | 871 (29.6) | 0 | 239 (33.5) | 264 (28.3) | 368 (28.3) | 0.029 |
| Dyslipidaemia, N (%) | 1768 (60.3) | 13 | 458 (64.6) | 569 (61.1) | 741 (57.3) | 0.005 |
| Renal impairment, N (%) | 959 (33.2) | 58 | 229 (32.8) | 318 (34.7) | 412 (32.4) | 0.510 |
| Prior ischaemic stroke, N (%) | 984 (33.4) | 0 | 262 (36.7) | 290 (31.0) | 432 (33.3) | 0.052 |
| History of ICH, N (%) | 60 (2.0) | 0 | 13 (1.8) | 14 (1.5) | 33 (2.5) | 0.210 |
| Ischaemic heart disease, N (%) | 905 (30.7) | 0 | 232 (32.5) | 275 (29.4) | 398 (30.6) | 0.400 |
| Bioprosthetic heart valve, N (%) | 151 (5.1) | 0 | 54 (7.6) | 34 (3.6) | 63 (4.8) | 0.001 |
| Current smoking, N (%) | 249 (8.8) | 103 | 79 (11.8) | 69 (7.6) | 101 (8.0) | 0.006 |
| Active malignancy, N (%) | 236 (8.1) | 15 | 79 (11.1) | 63 (6.8) | 94 (7.3) | 0.002 |
| Prestroke mRS ≥3, N (%) | 567 (22.1) | 381* | 118 (18.5) | 198 (24.6) | 251 (22.3) | 0.021 |
| Ipsilateral stenosis ≥50%, N (%) | 452 (15.6) | 54 | 307 (43.4) | 65 (7.2) | 80 (6.3) | <0.001 |
| Ipsilateral stenosis <50%, N (%) | 496 (17.1) | 50 | 100 (14.1) | 200 (21.9) | 196 (15.3) | <0.001 |
| Medication at the time of stroke onset | ||||||
| Oral anticoagulant | 0 | |||||
| VKA, N (%) | 1272 (43.2) | 249 (34.9) | 548 (58.7) | 475 (36.6) | <0.001 | |
| DOAC, N (%) | 1674 (56.8) | 464 (65.1) | 386 (41.3) | 824 (63.4) | ||
| DOAC dose | 32 | |||||
| Full, N (%) | 925 (56.3) | 292 (63.8) | 121 (32.0) | 512 (63.5) | <0.001 | |
| Reduced, N (%) | 717 (43.7) | 166 (36.2) | 257 (68.0) | 294 (36.5) | ||
| DOAC dosing frequency | 215† | |||||
| One time per day, N (%) | 848 (58.1) | 247 (57.7) | 221 (66.4) | 380 (54.4) | <0.001 | |
| Two times per day, N (%) | 611 (41.9) | 181 (42.3) | 112 (33.6) | 318 (45.6) | ||
| DOAC mechanism of action | 0 | |||||
| Thrombin inhibitor, N (%) | 152 (9.1) | 39 (8.4) | 29 (7.5) | 84 (10.2) | 0.270 | |
| Factor Xa inhibitor, N (%) | 1522 (90.9) | 425 (91.6) | 357 (92.5) | 740 (89.8) | ||
| Additional antiplatelet, N (%) | 363 (12.3) | 4 | 119 (16.7) | 112 (12.0) | 132 (10.2) | <0.001 |
| Statin, N (%) | 1354 (46.4) | 30 | 371 (52.3) | 387 (41.7) | 596 (46.6) | <0.001 |
| Antihypertensive(s), N (%) | 2683 (91.9) | 27 | 652 (91.8) | 842 (90.7) | 1189 (92.8) | 0.210 |
| Stroke details | ||||||
| NIHSS on admission, median (IQR) | 6 (2–14) | 33 | 4 (2–10) | 8 (3–16) | 6 (2–14) | <0.001 |
| Intravenous thrombolysis, N (%) | 351 (11.9) | 2 | 46 (6.5) | 211 (22.6) | 94 (7.2) | <0.001 |
| Endovascular treatment, N (%) | 787 (26.8) | 6 | 110 (15.4) | 293 (31.4) | 384 (29.7) | <0.001 |
| Embolic infarct pattern, N (%) | 2317 (81.7) | 111 | 468 (67.3) | 805 (89.6) | 1044 (84.1) | <0.001 |
| Large vessel occlusion, N (%) | 1345 (46.2) | 32 | 241 (34.2) | 513 (55.6) | 591 (46.0) | <0.001 |
| Laboratory parameters on admission | ||||||
| INR, median (IQR) | 1.4 (1.1–1.9) | 100 | 1.4 (1.1–2.0) | 1.3 (1.1–1.6) | 1.4 (1.2–2.2) | <0.001 |
| Low anticoagulant activity, N (%)‡ | 957 (43.9) | 766§ | 128 (26.9) | 633 (82.1) | 196 (21.0) | <0.001 |
| Low VKA activity, N (%) | 737 (58.2) | 96 (39.3) | 528 (96.4) | 113 (23.8) | <0.001 | |
| Low DOAC activity, N (%) | 220 (24.1) | 32 (13.8) | 105 (47.1) | 83 (18.1) | <0.001 | |
| DOAC plasma level, ng/mL, median (IQR) | 83.9 (30–164) | 761§ | 110.1 (54.9–193.6) | 34.6 (1.0–93.5) | 100.9 (44.3–192.6) | <0.001 |
| Outcome at discharge | ||||||
| mRS ≥3, N (%) | 1543 (63.3) | 508¶ | 393 (62.8) | 516 (67.9) | 634 (60.3) | 0.004 |
| In-hospital death, N (%) | 204 (8.4) | 35 (5.6) | 78 (10.3) | 91 (8.7) | 0.007 | |
*Not collected in the centre Berlin (reporting period 2013–2015).
†Not collected in the centre Erlangen.
‡Defined in VKA-treated patients as INR <2.0 and in DOAC-treated patients as plasma level <30 ng/mL.
§DOAC plasma level on admission not collected in the centres Berlin, Mainz and George Washington University.
¶Not collected in the centre Mainz.
.DOAC, direct oral anticoagulant; ICH, intracranial haemorrhage; INR, international normalised ratio; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; VKA, vitamin K-antagonist.