Direct oral anticoagulants significantly reduced the risk of ischemic stroke (OR 0.53) compared to no therapy or antiplatelets in patients with atrial fibrillation and prior intracranial hemorrhage.
Meta-Analysis (n=8,318)
Yes
Do direct oral anticoagulants (DOACs) reduce ischemic stroke without increasing major bleeding in patients with atrial fibrillation and prior intracranial hemorrhage compared to no therapy or antiplatelets?
In patients with atrial fibrillation and prior intracranial hemorrhage, DOACs may reduce ischemic stroke risk without increasing mortality or major bleeding compared to no therapy or antiplatelets.
Effect estimate: OR 0.53 (95% CI 0.39-0.72)
Absolute Event Rate: 3.6% vs 7.4%
p-value: p=<0.001
Background: Patients with atrial fibrillation and a history of intracranial hemorrhage (ICH) face a dilemma when resuming anticoagulation therapy due to the risk of ICH recurrence versus the need for Ischemic stroke (IS) prevention. This study aims to evaluate the safety and efficacy of direct oral anticoagulants (DOAC) compared to no therapy or antiplatelets in these patients. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Electronic searches were performed in multiple databases (Cochrane, PubMed, Web of Science, Embase, Google Scholar, Scopus) up to March 1, 2024. We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) involving patients with atrial fibrillation and prior ICH. Studies compared the group with no therapy or antiplatelets (no-DOAC group). Outcomes assessed included mortality, IS, ICH recurrence, and major bleeding events. Results: = 0.15], while Heterogeneity was low for most outcomes. Conclusion: DOACs appear to reduce the risk of IS without increasing mortality or major bleeding in patients with atrial fibrillation and prior ICH. However, the risk of ICH recurrence remains uncertain. These findings suggest a potential role for DOACs in this high-risk population, but further RCTs are needed to confirm these results. Systematic review registration: Identifier CRD42024587511.
Sablot et al. (Fri,) conducted a meta-analysis in Atrial fibrillation and history of intracranial hemorrhage (n=8,318). Direct oral anticoagulants (DOACs) vs. No therapy or antiplatelets was evaluated on Ischemic stroke (OR 0.53, 95% CI 0.39-0.72, p=<0.001). Direct oral anticoagulants significantly reduced the risk of ischemic stroke (OR 0.53) compared to no therapy or antiplatelets in patients with atrial fibrillation and prior intracranial hemorrhage.