Direct oral anticoagulants were associated with a lower risk of recurrent stroke compared to warfarin in patients with atrial fibrillation and a history of stroke (HR 0.67; 95% CI 0.62-0.72).
Cohort (n=61,568)
Do direct oral anticoagulants reduce recurrent stroke, major bleeding, and mortality compared to warfarin in OAC-naïve Asian patients with non-valvular atrial fibrillation and a history of stroke?
In Asian patients with non-valvular atrial fibrillation and a history of stroke, DOACs are associated with significantly lower risks of recurrent stroke, major bleeding, and mortality compared to warfarin.
Effect estimate: HR 0.67 (95% CI 0.62-0.72)
We investigated the effectiveness and safety of direct oral anticoagulants (DOACs) for secondary prevention in patients with atrial fibrillation (AF), particularly focusing on subgroups of patients with severe, disabling, and recent stroke. Using the Korean National Health Insurance Service claims database between January 2010 and April 2018, we selected OAC-naïve patients with non-valvular AF and a history of stroke. Cumulative risks for recurrent stroke, major bleeding, composite outcome (recurrent stroke + major bleeding), and mortality were compared between DOAC and warfarin groups. Among 61,568 patients, 28,839 and 32,729 received warfarin and DOACs, respectively. Compared with warfarin, DOACs were associated with lower risks of recurrent stroke (hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.62-0.72), major bleeding (HR 0.73, 95% CI 0.66-0.80), composite outcome (HR 0.69, 95% CI 0.65-0.73), and mortality. DOAC use resulted in a consistent trend of improved outcomes in the subgroups of patients with severe, disabling, and recent stroke. In conclusion, DOACs were associated with lower risks of recurrent stroke, major bleeding, composite clinical outcomes, and mortality in patients with AF and a history of stroke. These results were consistent across all types of DOACs and subgroups of patients with severe, disabling, and recent stroke.
Park et al. (Tue,) conducted a cohort in Non-valvular atrial fibrillation with a history of stroke (n=61,568). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Recurrent stroke (HR 0.67, 95% CI 0.62-0.72). Direct oral anticoagulants were associated with a lower risk of recurrent stroke compared to warfarin in patients with atrial fibrillation and a history of stroke (HR 0.67; 95% CI 0.62-0.72).