Key result
In AF patients with previous stroke/TIA, NOAC use was associated with a decreased risk of stroke compared to VKAs (HR 0.82; 95% CI 0.69-0.97).
Why the study?
Several observational studies had evaluated NOACs versus VKAs in AF patients with prior stroke, TIA, or intracranial hemorrhage, prompting a meta-analysis to synthesize effectiveness and safety outcomes.
Do non-vitamin K antagonist oral anticoagulants reduce stroke, bleeding, and death compared to vitamin K antagonists in atrial fibrillation patients with previous stroke or intracranial hemorrhage?
Meta-Analysis
Do non-vitamin K antagonist oral anticoagulants reduce stroke, bleeding, and death compared to vitamin K antagonists in atrial fibrillation patients with previous stroke or intracranial hemorrhage?
NOACs demonstrate superior efficacy and safety compared to VKAs in high-risk AF patients with a history of stroke, TIA, or intracranial hemorrhage.
Answers are grounded in this paper and cite their sources.
May support preferring NOACs over VKAs in AF with prior stroke/TIA or ICH; leaves open randomized confirmation.
Several observational studies have compared the effectiveness and safety outcomes between nonvitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients with a history of either stroke/transient ischemic attack (TIA) or intracranial hemorrhage. Therefore, our current meta-analysis aimed to address this issue. The Cochrane Library, PubMed, and Embase databases were systematically searched until December 2020 for all relevant observational studies. We applied a random-effects model to pool adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for this meta-analysis. A total of 10 studies were included. Among patients with a history of stroke/TIA, the use of NOACs versus VKAs was associated with decreased risks of stroke (HR, 0.82, 95% CI 0.69-0.97), systemic embolism (HR, 0.73, 95% CI 0.61-0.87), all-cause death (HR, 0.87, 95% CI 0.81-0.94), major bleeding (HR, 0.77, 95% CI 0.64-0.92) and intracranial hemorrhage (HR, 0.54, 95% CI 0.38-0.77). Among patients with a history of intracranial hemorrhage, the use of NOACs versus VKAs was associated with reduced risks of stroke (HR, 0.81, 95% CI 0.68-0.95), all-cause death (HR, 0.68, 95% CI 0.49-0.94), and intracranial hemorrhage (HR, 0.66, 95% CI 0.51-0.84). Compared with VKAs, the use of NOACs exhibited superior efficacy and safety outcomes in AF patients with previous stroke/TIA, and the use of NOACs was associated with reduced risks of stroke, all-cause death, and intracranial hemorrhage in patients with a history of intracranial hemorrhage.
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Guo et al. (2021) conducted a meta-analysis in Atrial fibrillation with previous stroke, TIA, or intracranial hemorrhage. Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Stroke (in patients with a history of stroke/TIA) (HR 0.82, 95% CI 0.69-0.97). In AF patients with previous stroke/TIA, NOAC use was associated with a decreased risk of stroke compared to VKAs (HR 0.82; 95% CI 0.69-0.97).
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