Efficacy and Safety of Direct Oral Anticoagulants (DOACs) Versus Warfarin in Atrial Fibrillation Patients with Prior Stroke: a Systematic Review and Meta-analysis

Umashankar, Kandavadivu; Mammi, Marco; Badawoud, Ebtissam; Tang, Y; Zhou, M; Borges, Jorge; Liew, Aaron; Migliore, Mattia M.; Mekary, Rania A.

doi:10.1007/s10557-022-07336-w

Cited by 3 publications

(3 citation statements)

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“…Bei Nierengesunden liegen genug Studienergebnisse vor, die den breiten Einsatz von DOAC bei NAVF im Gegensatz zu VKA empfehlen [11]. Daher befürworten die aktuellen ESC-Leitlinien den Einsatz von DOAC zur Senkung des Schlaganfallrisikos [12].…”

Section: Vergleich Von Vitamin-k-antagonisten Und Direkt Wirkenden Or...unclassified

Gerinnungsmanagement in der schweren, fortgeschrittenen Niereninsuffizienz

Schettler

Schlieper²

2022

Aktuelle Kardiologie

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ZusammenfassungPatienten mit chronischer Niereninsuffizienz (CKD) haben ein hohes Risiko für nicht valvuläres Vorhofflimmern (NVAF) und häufig ein höheres Risiko für venöse Thromboembolien (VTE) aufgrund ihrer Grunderkrankungen wie z. B. Diabetes. Bisher kamen Vitamin-K-Antagonisten (VKA) auch bei diesen Patienten in Deutschland zum Einsatz. VKA haben ein erhöhtes Blutungsrisiko und werden als Risikofaktor für eine Verschlechterung der Nierenfunktion und/oder Gefäßsituation (Athero- und Mediasklerose) von Patienten diskutiert. Aus diesen Gründen und den vorliegenden Studiendaten werden deshalb direkt wirkende orale Antikoagulanzien (DOAC) auch bei Patienten mit NVAF und CKD (G1–G3) in den Leitlinien empfohlen. Allerdings kann keine klare Empfehlung für den Einsatz von DOAC bei Dialysepatienten gegeben werden. Heparine spielen in diesem Zusammenhang nur eine untergeordnete Rolle.

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Section: Vergleich Von Vitamin-k-antagonisten Und Direkt Wirkenden Or...unclassified

Gerinnungsmanagement in der schweren, fortgeschrittenen Niereninsuffizienz

Schettler

Schlieper²

2022

Aktuelle Kardiologie

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“…Of course, subgroup analysis or meta-analysis of pivotal RCT participants have repeatedly shown that NOAC is more effective and safer than warfarin for secondary prevention of thromboembolic events in patients with a history of stroke or transient ischemic attack (TIA). [18][19][20][21][22][23] However, these studies were originally designed to evaluate the primary prevention of stroke, and acute or severe stroke patients were excluded. Therefore, the results did not accurately re ect the real-world outcomes experienced by acute ischemic stroke (AIS) patients with NVAF during treatment.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Non-Vitamin K Oral Anticoagulants for Secondary Prevention in Ischemic Stroke with Atrial Fibrillation

Nam,

Kwon,

Lee

et al. 2023

Preprint

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Previous studies have rarely investigated the role of non-vitamin K oral anticoagulants (NOAC) and warfarin in the secondary prevention of ischemic stroke patients with nonvalvular atrial fibrillation (NVAF). In this study, we compared the effectiveness and safety of NOAC and warfarin for secondary prevention in Korean ischemic stroke patients with NVAF. Based on the Korean National Health Insurance Service Database, this study included 21,064 oral anticoagulants-naïve acute ischemic stroke patients with NVAF between July 2015 and June 2019. The main study outcomes included ischemic stroke, systemic embolism, major bleeding, and death. During the observational periods, NOAC users had a significantly decreased risk of ischemic stroke + systemic embolism (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.78–0.95), ischemic stroke (aHR, 0.89; 95% CI, 0.81–0.99), major bleeding (aHR, 0.78; 95% CI, 0.68–0.89), and all-cause death (aHR, 0.87; 95% CI, 0.81–0.93). Standard-dose NOAC users had a lower risk of ischemic stroke, systemic embolism, and major bleeding events than warfarin users. In contrast, low-dose NOAC users did not differ in risk from warfarin users for all outcomes. In conclusion, NOACs were associated with a lower risk of secondary thromboembolic events and bleeding complications in Korean ischemic stroke patients with NVAF than warfarin.

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“…ПОАК также на 10% снижали смертность от всех причин (RR 0,9; 95% ДИ 0,85-0,95; p=0,0003) и риск внутричерепного кровоизлияния (ВЧК; RR 0,48; 95% ДИ 0,39-0,59; p<0,0001), однако на фоне их приема увеличивался риск желудочно-кишечных кровотечений (RR 1,25; 95% ДИ 1,01-1,55; р=0,04). В другом метаанализе [17] сравнивались эффективность и безопасность ПОАК и варфарина у пациентов с инсультом в анамнезе ( осложнения [отношение рисков (ОР) 0,89; 99% ДИ 0,83-0,96], были ниже общая смертность (ОР 0,88; 95% ДИ 0,82-0,95), риск госпитализации (ОР 0,93; 95% ДИ 0,88-0,97), госпитализации, связанной с заболеванием сердечно-сосудистой системы (ОР 0,92; 95% ДИ 0,86-0,99), ГИ (ОР 0,69; 95% ДИ 0,50-0,95) и госпитализаций по поводу кровотечений (ОР 0,89; 95% ДИ 0,81-0,97).…”

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Anticoagulant therapy as a part of secondary stroke prevention in patients with atrial fibrillation

Остроумова

2022

RJTAO

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Atrial fibrillation (AF) is the main cause of cardioembolic ischemic stroke (IS), it occurs in 25–35% of patients with IS, and its presence increases the risk of recurrent stroke compared with patients with sinus rhythm. The main method of preventing recurrent IS in AF is the administration of oral anticoagulants (OACs); in non-valvular AF, direct OACs (DOACs) have an advantage. Meta-analysis of randomized clinical trials showed a 19% greater reduction of stroke and systemic embolism risk in the DOACs group compared to warfarin (p<0.0001), including a 51% greater hemorrhagic stroke (HS) risk reduction (p<0.0001). In an additional sub-analysis of the ARISTOTLE trial, patients with AF and a history of stroke/transient ischemic attack showed a significant reduction in the risk of all types of strokes and HS. Although no randomized trial explored the direct comparisons of drugs from the DOACs group, data from observational studies indicate the potential advantage of apixaban in terms of reducing the risk of IS. Russian 2020 clinical guidelines for AF treatment suggest that the resumption/initiation (1–3–12 days) of anticoagulant therapy after an IS should be determined by the decision of a multidis ciplinary team (neurologist, cardiologist, neuroimaging specialist) based on recurrent IS and bleeding risk assessment. According to the 2020 guidelines of the Ministry of Health, the resumption of OACs therapy after an intracranial hemorrhage in patients with AF may be recommended 4–8 weeks after the event, and the decision to reinitiate therapy, as well as after IS, should be made by a multidisciplinary team.

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Efficacy and Safety of Direct Oral Anticoagulants (DOACs) Versus Warfarin in Atrial Fibrillation Patients with Prior Stroke: a Systematic Review and Meta-analysis

Cited by 3 publications

References 78 publications

Gerinnungsmanagement in der schweren, fortgeschrittenen Niereninsuffizienz

Gerinnungsmanagement in der schweren, fortgeschrittenen Niereninsuffizienz

Outcomes of Non-Vitamin K Oral Anticoagulants for Secondary Prevention in Ischemic Stroke with Atrial Fibrillation

Anticoagulant therapy as a part of secondary stroke prevention in patients with atrial fibrillation

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