Key result
NOAC use for secondary stroke prevention in AF patients was associated with a lower 30-day mortality risk after intracranial hemorrhage compared to VKAs (meta-analysis RR 0.70; 95% CI 0.51-0.95).
Why the study?
Potential differences in the incidence, characteristics, and outcomes between intracranial haemorrhages associated with NOACs versus VKAs after treatment initiation for AF in ischaemic stroke patients were unclear.
Do NOACs reduce the risk of fatal intracranial haemorrhage compared to VKAs in AF patients receiving secondary stroke prevention?
Population
4912 eligible AF patients admitted with ischaemic stroke or TIA receiving VKAs or NOACs
Comparison
NOACs vs VKAs
Design
Pooled analysis of seven multicentre cohorts and meta-analysis of observational studies
Follow-up
5970 patient-years
Authors
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May support preferring NOACs for secondary AF stroke prevention; leaves open causal inference from this observational meta-analysis.
Cohort (n=4,912)
Yes
Do NOACs reduce the risk of fatal intracranial haemorrhage compared to VKAs in AF patients receiving secondary stroke prevention?
Hazard Ratio: 0.32 (95% CI 0.09–1.14)
Absolute Event Rate: 0.11% vs 0.32%
In AF patients receiving secondary stroke prevention, intracranial hemorrhages associated with NOACs have a lower 30-day mortality risk compared to those associated with VKAs.
Tsivgoulis et al. (2020) conducted a cohort in Atrial fibrillation with ischaemic stroke or transient ischaemic attack (n=4,912). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Fatal intracranial haemorrhage (death occurring during the first 30 days after ICH onset) (HR 0.32, 95% CI 0.09-1.14). NOAC use for secondary stroke prevention in AF patients was associated with a lower 30-day mortality risk after intracranial hemorrhage compared to VKAs (meta-analysis RR 0.70; 95% CI 0.51-0.95).
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