Key result
Oral anticoagulants showed no significant efficacy benefit over aspirin after cryptogenic stroke, but rivaroxaban significantly increased the risk of major bleeding (RR 2.69; 95% CI 1.67-4.33).
Why the study?
Although several antithrombotic strategies have been investigated for cryptogenic stroke, the optimal antithrombotic regimen remains unknown.
Do oral anticoagulants reduce mortality and stroke recurrence compared to aspirin in patients with cryptogenic stroke?
Meta-Analysis (n=15,240)
Do oral anticoagulants reduce mortality and stroke recurrence compared to aspirin in patients with cryptogenic stroke?
In patients with cryptogenic stroke, oral anticoagulants do not offer superior efficacy over aspirin, and rivaroxaban is associated with a higher risk of major bleeding.
Supports aspirin preference after cryptogenic stroke; confirms no efficacy benefit and rivaroxaban bleeding harm in meta-analysis.
Although several antithrombotic strategies have been investigated for the management of cryptogenic strokes, ie, ischemic strokes without known etiologies, an optimal antithrombotic strategy for cryptogenic strokes is unknown. We aim to assess oral antithrombotic agents' comparative efficacy and safety after cryptogenic stroke to identify an optimal treatment.A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and Web of Science until February 2024. We used the random-effects model to report dichotomous outcomes using a risk ratio (RR) with a 95% confidence interval (CI). Frequentist network meta-analysis was conducted using R, version 4.3.1.Seven RCTs with 15,240 patients were included. None of the OACs showed a significant efficacy in preventing all-cause mortality, stroke recurrence, cardiovascular mortality, and major adverse cardiac events compared to aspirin. Also, safety measures were similar between different OACs and aspirin regarding safety measures, including major bleeding, intracranial hemorrhage, and gastrointestinal bleeding. However, only rivaroxaban significantly increased the incidence of major bleeding (RR: 2.69, CI [1.67, 4.33]).There was no difference between various OACs and aspirin regarding efficacy and safety outcomes. There is a greater risk of major bleeding with rivaroxaban. Further research is still warranted to define a personalized strategy for selecting antithrombotic strategies after cryptogenic stroke on a case-by-case basis.
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Abuelazm et al. (2024) conducted a meta-analysis in Cryptogenic stroke (n=15,240). Oral anticoagulants (OACs) vs. Aspirin was evaluated on All-cause mortality, stroke recurrence, cardiovascular mortality, and major adverse cardiac events. Oral anticoagulants showed no significant efficacy benefit over aspirin after cryptogenic stroke, but rivaroxaban significantly increased the risk of major bleeding (RR 2.69; 95% CI 1.67-4.33).
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