# Eerdere beroerte en verminderde NOAC-dosering geassocieerd met ischemische beroerte bij atriumfibrilleren

*geplaatst 2026-10-25 · Nierziekte · Medicine · doi 10.1097/MD.0000000000051189 · https://hartvaat.nl/2026/10/16/eerdere-beroerte-en-verminderde-noac-dosering-geassocieerd-met-ischemische-beroe/*

Een retrospectieve case-controlstudie onderzocht bij 322 patiënten met niet-valvulair atriumfibrilleren op NOAC-therapie welke factoren geassocieerd zijn met een acute ischemische beroerte. In de multivariaat gecorrigeerde analyse bleken een eerdere beroerte (OR 32,79), coronairlijden (OR 3,47), een verminderde NOAC-dosering (OR 2,55), vrouwelijk geslacht (OR 2,26) en diabetes (OR 1,99) significant met beroerte geassocieerd. Voor de klinische praktijk benadrukt dit onderzoek het belang van zorgvuldige doseringskeuzes en het monitoren van cardiovasculaire comorbiditeiten bij NOAC-gebruikers, hoewel prospectieve validatie nodig is om de bevindingen te bevestigen.

## English: Acute ischemic stroke despite NOAC therapy in atrial fibrillation: Clinical factors associated with AIS in a 2-center observational case-control study.

A retrospective case-control study evaluated clinical factors associated with acute ischemic stroke in 322 patients with non-valvular atrial fibrillation treated with NOACs for at least three months. Multivariable analysis identified prior stroke (OR 32.79), coronary artery disease (OR 3.47), prescribed reduced-dose NOAC use (OR 2.55), female sex (OR 2.26), and diabetes (OR 1.99) as significant predictors. These findings highlight the need for careful dose selection and vigilant management of cardiovascular comorbidities in NOAC-treated patients, though prospective studies are required to confirm the results.

## Abstract (original, from the publication)

Acute ischemic stroke (AIS) can occur in patients with non-valvular atrial fibrillation (AF) despite treatment with non-vitamin K antagonist oral anticoagulants (NOACs). This study evaluated clinical, treatment-related, inflammatory, and echocardiographic factors associated with AIS in NOAC-treated patients with AF. This retrospective, 2-center case-control study included 322 patients with non-valvular AF who had received NOAC therapy for at least 3 months. Of these, 112 were hospitalized with AIS and 210 were outpatient controls without AIS at the study assessment. Group differences and factors associated with AIS were evaluated using multivariable logistic regression. ROC analyses were exploratory. Patients with AIS were older than controls and more often had hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, prior stroke, and prescribed reduced-dose NOAC use. In the adjusted analysis, prior stroke (OR = 32.79), coronary artery disease (OR = 3.47), prescribed reduced-dose NOAC use (OR = 2.55), female sex (OR = 2.26), diabetes mellitus (OR = 1.99), and C-reactive protein (OR per mg/L = 1.10) were associated with AIS. HAS-BLED (area under the curve = 0.881, 95% CI = 0.844-0.918) and CHA2DS2-VASc (area under the curve = 0.840, 95% CI = 0.795-0.885) distinguished AIS cases from controls in exploratory ROC analyses. Among NOAC-treated patients with AF, prior stroke and cardiovascular comorbidities were strongly associated with AIS. Prescribed reduced-dose NOAC use was also associated with AIS. Inflammatory markers measured during acute stroke had limited additional value. Because this was a case-control study, the findings do not estimate stroke incidence or future stroke risk and require prospective validation.

Auteurs: Zeynep Bastug Gul, Nasrullah Danisman, Ebru Ozbezen Kiziltan, Gulhan Yildirim Ozdemir, Vasfiye Kabeloglu, Serkan Yazan, Mehmet Gul

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Bron: Medicine, https://doi.org/10.1097/MD.0000000000051189. Bijgewerkt 2026-10-18T01:09:54Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.