Why the study?
Do new oral anticoagulants reduce stroke or systemic embolism compared to warfarin in patients with non-valvular atrial fibrillation and prior stroke or TIA?
Do new oral anticoagulants reduce stroke or systemic embolism compared to warfarin in patients with non-valvular atrial fibrillation and prior stroke or TIA?
New oral anticoagulants provide similar efficacy to warfarin for secondary stroke prevention in atrial fibrillation, but with a significantly lower risk of intracranial bleeding.
May favor NOACs over warfarin for secondary AF prevention due to lower intracranial bleeding; leaves open need for dedicated RCTs.
Vitamin K antagonists, such as warfarin, used in oral anticoagulation therapy currently represent the standard drugs for the primary and secondary prevention of stroke in non-valvular atrial fibrillation (AF), with a relative risk reduction close to 70%. Newer oral anticoagulants, such as direct thrombin inhibitors (i.e., dabigatran) and direct factor Xa inhibitors (i.e., apixaban and rivaroxaban) have been recently compared with warfarin in large randomized trials for stroke prevention in AF. The new oral anticoagulants showed, compared with warfarin, no statistically significant difference in the rate of stroke or systemic embolism in secondary prevention (patients with previous transient ischemic attack or stroke) subgroups. With regard to safety, the risk of intracranial bleeding was reduced with new anticoagulants compared with warfarin. Indirect treatment comparisons of clinical trials on secondary prevention cohorts showed no significant difference in efficacy among apixaban, rivaroxaban, and dabigatran; but dabigatran 110 mg was associated with less intracranial bleedings than rivaroxaban.
No takes yet. Share an insight, caveat, or question.
Sacquegna et al. (2015) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: