[Prevalence of direct oral anticoagulant users among patients with acute ischemic stroke].

INTRODUCTION

Despite the use of direct oral anticoagulants (DOACs), acute ischemic stroke can occur for several reasons. According to international data, 20% of patients with acute ischemic stroke take DOACs, but no comprehensive analysis of this occurrence has been available in Hungary to date.

OBJECTIVE

Our aim was to determine the prevalence of DOAC users in Hungarian ischemic stroke patients.

METHOD: We used retrospective analysis of the Semmelweis University stroke registry to evaluate DOAC use in patients with acute ischemic stroke treated consecutively between October 2020 and September 2024.

RESULTS

Among the 2918 consecutive patients with acute ischemic stroke within 24 hours, 320 were taking DOAC (10,57%), of these, 276 (86,25%) had a history of atrial fibrillation. 183 patients (57%) were treated with apixaban, 72 (23%) with rivaroxaban, 38 (12%) with dabigatran, and 27 (8%) with edoxaban. Regarding thrombolysis time windows, 173 out of 1379 (12.54%) patients within the standard intravenous thrombolysis window (0-4.5 h) and 63 out of 656 (9.6%) patients within the extended thrombolysis window (4.5-9 h) were receiving DOAC treatment. Among acute ischemic stroke patients taking DOACs, the proportion of women was higher (56.7%), and the average age for was significantly greater (76 years) compared to the overall acute ischemic population (70 years).

DISCUSSION: The 10.57% prevalence of DOAC use among acute ischemic stroke patients was significantly lower than the 20% observed in international data. This discrepancy may be attributable to the later introduction of DOACs in Hungary, differing reimbursement policies, and high drug costs. Further studies are needed to explore the factors explaining this difference and their impact on stroke prevention.

CONCLUSION

The rate of DOAC use among Hungarian acute ischemic stroke patients was below the international average, which warrants targeted studies to optimize anticoagulation strategies. Orv Hetil. 2026; 167(20): 779-783.