Key result
Direct oral anticoagulants reduced the relative risk of stroke and systemic embolism by 15% compared to warfarin in patients with atrial fibrillation.
Why the study?
Treatment decisions are difficult for individuals with co-morbid atrial fibrillation and arterial origin stroke, leaving the optimal antithrombotic therapy uncertain.
Does anticoagulant therapy alone or combined with antiplatelet therapy reduce stroke and systemic embolism in patients with AF and arterial origin stroke?
Meta-Analysis (n=77,048)
Does anticoagulant therapy alone or combined with antiplatelet therapy reduce stroke and systemic embolism in patients with AF and arterial origin stroke?
Relative Risk: 0.85 (95% CI 0.75–0.97)
p-value: p=0.012
DOACs alone may be sufficient to prevent stroke recurrence without increasing bleeding risk in patients with AF and arterial origin stroke, whereas adding aspirin increases bleeding without added benefit.
Supports preferring DOACs over warfarin for AF stroke prevention; extends evidence favoring monotherapy without added aspirin benefit.
Abstract Background Anticoagulation and antiplatelet therapy were adopted respectively for the prevention ofcardio-embolic stroke or arterial origin stroke. while it’s difficult to make decisions for individual with Atrial fibrillation(AF)and arterial origin stroke as comorbidities, so we attempted to evaluate the efficacy and safety ofanticoagulants and antiplatelet forthe prevention of stroke in AF with arterial origin stroke and make an optimal treatment for these comorbidities. Methods Databases included PubMed, Cochrane Library and ClinicalTrials.gov were searched up to 31 Aug 2019. Eight RCTs with 77048 participants were enrolled. Results Direct oral anticoagulants(DOACs) reduced the relative risk of stroke and systemic embolism by 15% (95%CI 0.75-0.97, I2=65.6%) and the major bleeding by 23%(95%CI 0.63-0.95, I2=92.3%,). DOACs or warfarin plus aspirin compared with DOACs or warfarin alone did not show the benefit on stroke and systemic embolism prevent in AF patients, but increase the risk of major bleeding with RR 1.40 (95%CI 1.13-1.75,) and 1.33（95%CI 1.09-1.63）respectively. No differences in preventionof ischemic stroke were detected between OACs versus aspirin in arterial origin stroke. The major bleeding was significantly higher in the OACs group (RR,2.40,1.46-3.94, I2=62.2%). However, compared with aspirin, rivaroxabandid not increase the risk of major bleeding in Branch atheromatous stroke (RR,1.54,95%CI 0.26-9.12). Conclusions We speculatedthat DOACs alone may be enough to prevent stroke recurrence and not to increase the risk of bleeding in AF patients with arterial origin stroke. The well designed RCTs with the direct comparison would be needed in future.
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Li et al. (2019) conducted a meta-analysis in Atrial fibrillation and arterial origin stroke (n=77,048). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Composite of stroke and systemic embolism (RR 0.85, 95% CI 0.75-0.97, p=0.012). Direct oral anticoagulants reduced the relative risk of stroke and systemic embolism by 15% compared to warfarin in patients with atrial fibrillation.
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