Real-World Setting Comparison of Nonvitamin-K Antagonist Oral Anticoagulants Versus Vitamin-K Antagonists for Stroke Prevention in Atrial Fibrillation

Ntaios, George; Papavasileiou, Vasileios; Makaritsis, Konstantinos; Vemmos, Konstantinos; Michel, Patrik; Lip, Gregory Y.H.

doi:10.1161/strokeaha.117.017549

Cited by 202 publications

(168 citation statements)

References 43 publications

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“…In phase III trials, all were at least non-inferior to warfarin for preventing stroke and systemic embolism, with about half the rate of intracranial haemorrhage 81–84. These clinical trial data are strongly supported by data from observational studies in ‘real world’ populations 85. Our practice, supported by European guidelines,8 is to recommend a DOAC to all patients without a specific indication for a vitamin K antagonist (eg, a mechanical prosthetic heart valve or significant mitral stenosis)86 (box 1).…”

Section: Starting An Anticoagulantmentioning

confidence: 90%

Atrial fibrillation and stroke: a practical guide

et al. 2019

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Neurologists and stroke physicians will be familiar with atrial fibrillation as a major cause of ischaemic stroke, and the role of anticoagulation in preventing cardioembolic stroke. However, making decisions about anticoagulation for individual patients remains a difficult area of clinical practice, balancing the serious risk of ischaemic stroke against that of major bleeding, particularly intracranial haemorrhage. Atrial fibrillation management requires interdisciplinary collaboration with colleagues in cardiology and haematology. Recent advances, especially the now-widespread availability of direct oral anticoagulants, have brought opportunities to improve stroke care while posing new challenges. This article gives an overview of the contemporary diagnosis and management of atrial fibrillation, and the associated evidence base. Where there is uncertainty, we describe our own approach to these areas, while highlighting ongoing research that will likely guide future practice.

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Section: Starting An Anticoagulantmentioning

confidence: 90%

Atrial fibrillation and stroke: a practical guide

et al. 2019

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“…23,24 Clinical trials and real-world setting data provide consistent observations of a lower incidence of intracranial bleeding with DOACs; however, there is a higher risk of gastrointestinal hemorrhage when compared with VKAs. 25,26 Data from dabigatran registry (Global Registry on Long-term Oral Anti-thrombotic Treatment in Patients with Atrial Fibrillation) and real-world data show that the majority of major bleeding events in dabigatran occur during the first 12 months of therapy. 27,28 In our study, one patient on dabigatran developed gastrointestinal bleeding with hemopericardium that required reversal with the antidote.…”

Section: Discussionmentioning

confidence: 99%

Dabigatran as an oral anticoagulant in patients with Budd–Chiari syndrome post‐percutaneous endovascular intervention

Sharma

Kumar

Rout

et al. 2019

J of Gastro and Hepatol

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Background and Aim Anticoagulants play an important role in the management of Budd–Chiari syndrome. There is a paucity of data on the efficacy and safety of direct‐acting oral anticoagulants—dabigatran, among patients with Budd–Chiari syndrome. Methods In a retrospective analysis of prospectively maintained data, the stent patency rates, major bleeding episode, and a composite endpoint of major bleed and/or mortality rates were compared between Budd–Chiari syndrome patients treated with dabigatran (n = 36) or vitamin K antagonists (n = 62) following endovascular intervention. Results The baseline characteristics, including sites of block and types of interventions, were similar between the two groups. The mean duration of follow‐up in the dabigatran and vitamin K antagonist groups was 10.5 ± 6.7 and 14.1 ± 6.9 months (P = 0.006), respectively. The endovascular stent patency rates were comparable between the dabigatran and vitamin K antagonist groups at 6 months (91% vs 96.5%) and 12 months (91% vs 93%), P = 0.296 (log‐rank test), respectively. Major bleeding events were comparable between the dabigatran and vitamin K antagonist groups at 6 months (3.5% vs 2%) and 12 months (3.5% vs 6.5%), P = 0.895 (log‐rank test), respectively. The composite endpoint of mortality and major bleed was comparable between dabigatran and vitamin K antagonists at 6 months (4% vs 5%) and 12 months (4% vs 8%), P = 0.875 (log‐rank test), respectively. Conclusions Dabigatran, as compared with vitamin K antagonists, is associated with similar stent patency rates and complications among patients with Budd–Chiari syndrome post‐endovascular intervention.

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“…2 Nevertheless, the high proportion is concerning considering the extensive use of the Danish population-based health care registers in the evaluation of safety and effectiveness of real-world DOAC use. 3 In such studies, safety and effectiveness are usually explored in the context of a specific treatment indication defined by the presence of a specific hospital-based diagnosis, such as AF. However, with this approach, many DOAC users potentially treated for the indication of interest, but without a registered diagnosis, will not be included.…”

Section: Cohort Selection In Register-based Studies Of Direct Oral Anmentioning

confidence: 99%

Cohort selection in register‐based studies of direct oral anticoagulant users with atrial fibrillation: An inevitable trade‐off between selection bias and misclassification

Hellfritzsch

Pottegård

Haastrup

et al. 2020

Basic Clin Pharma Tox

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Real-World Setting Comparison of Nonvitamin-K Antagonist Oral Anticoagulants Versus Vitamin-K Antagonists for Stroke Prevention in Atrial Fibrillation

Abstract: This meta-analysis confirms the main findings of the randomized controlled trials of dabigatran, rivaroxaban, and apixaban in the real-world setting and, hence, strengthens their validity.

Cited by 202 publications

References 43 publications

Atrial fibrillation and stroke: a practical guide

Atrial fibrillation and stroke: a practical guide

Dabigatran as an oral anticoagulant in patients with Budd–Chiari syndrome post‐percutaneous endovascular intervention

Cohort selection in register‐based studies of direct oral anticoagulant users with atrial fibrillation: An inevitable trade‐off between selection bias and misclassification

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