Background: Endothelial dysfunction is a key player in stroke pathophysiology. The Endothelial Activation and Stress Index (EASIX) is a biomarker of endothelial injury validated in hematology, sepsis, and cardiovascular cohorts; however, its prognostic role in stroke remains unclear. This retrospective cohort study aims to provide preliminary evidence on the potential utility of EASIX levels as a biomarker for assessing stroke severity and predicting outcomes. Methods: We retrospectively studied 100 patients aged ≥ 18 years admitted with acute ischemic stroke (AIS) or transient ischemic attack (TIA) between January 2020 and July 2024. EASIX was calculated on admission as LDH × creatinine/platelets. Outcomes included in-hospital and 12-month mortality, stroke severity assessed by the NIHSS score, and disability assessed as a modified Rankin score (mRS). Results: Median age was 82 years; 56% were female. The in-hospital and 12-month mortality rates were 47.9% in patients with AIS and 17.2% in patients with TIA, respectively. Overall, EASIX was not associated with NIHSS, mRS, or mortality in the total cohort. Ιn the subgroup of patients with small vessel disease (n = 10), higher EASIX was associated with worse mRS at 12 months (β = 2.383, p = 0.02) and increased mortality (β = 0.653, p = 0.02). EASIX correlated positively with WBC (p < 0.001) and CRP (p = 0.01). Female sex was associated with lower EASIX values. Conclusions: EASIX was not associated with outcomes in the overall AIS/TIA cohort, but it demonstrated potential prognostic relevance in small vessel disease (SVD), which has not been reported previously in the literature. Further prospective research is warranted to validate the potential association between systemic endothelial stress and small vessel disease before the implementation of EASIX as a prognostic tool in patients with stroke due to SVD.

Background: Anticoagulant treatment is central to the prevention and management of thromboembolic cardiovascular disease, and contemporary practice has increasingly shifted toward direct oral anticoagulants. Objectives: To quantify ambulatory anticoagulant utilization trends in Greece during 2018 to 2022 and to forecast utilization through 2030 using standardized drug-utilization metrics. Methods: A retrospective pharmacoepidemiological analysis of community-pharmacy anticoagulant sales data in Greece was performed using IQVIA Greece data as a proxy for population-level drug consumption. Utilization was standardized as defined daily doses per 1000 inhabitants per day. Drug-specific temporal trends were evaluated, and seasonal autoregressive integrated moving average models were developed to generate forecasts through 2030. Results: Total sales-based anticoagulant consumption increased by 31.1%, from 24.84 defined daily doses per 1000 inhabitants per day in 2018 to 32.57 in 2022, corresponding to an average annual increase of 1.57. This increase was primarily driven by direct oral anticoagulants, particularly apixaban, which increased from 5.03 ± 0.36 to 9.91 ± 0.46, and rivaroxaban, which increased from 6.84 ± 0.32 to 9.38 ± 0.29. In contrast, acenocoumarol declined by 37.6%, from 4.02 ± 0.17 to 2.51 ± 0.08. Among parenteral anticoagulants, enoxaparin increased from 1.87 ± 0.11 to 2.65 ± 0.15, whereas nadroparin decreased from 0.06 ± 0.01 to 0.02 ± 0.01. By 2030, apixaban and rivaroxaban are forecast to reach 19.61 (95% CI 18.45 to 20.77) and 9.29 (95% CI 5.09 to 13.49), respectively, whereas acenocoumarol is projected to decline to 0.97 (95% CI 0.72 to 1.23). Conclusions: Sales-based anticoagulant consumption shifted toward direct oral anticoagulants, with concurrent declines in vitamin K antagonists and selected parenteral agents, trends that may inform cardiovascular care planning, reimbursement policy, and implementation of evidence-based anticoagulation strategies.