Two-Year Outcomes of Anticoagulation for Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation　― SAMURAI-NVAF Study ―

Abstract

Stroke/TIA patients receiving DOACs for secondary prevention were younger and had lower stroke severity and risk indices than those receiving warfarin. Estimated cumulative incidences of stroke and systemic embolism within 2 years were similar between warfarin and DOACs users, but those of death and intracranial hemorrhage were significantly lower among DOAC users.

Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation

“…The following studies were included: the single center prospective cohort studies from Verona/Italy, 19 Erlangen/Germany, 20 Basel/Switzerland ("Novel oral anticoagulants in stroke patients"/NOACISP), 23 and the multicenter cohort studies "Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation" (RAF 21 and RAF-NOAC 22 ; 29 centers in Europe and Asia), "The Clinical Relevance of Microbleeds in Stroke study" (CROMIS-2; 79 centers in the UK and one in the Netherlands), 26,27 and "The Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Non-Valvular Atrial Fibrillation Study" (SAMURAI-NVAF; 18 centers in Japan). 18,24,28 Details about the participating studies can be obtained from Table 1 (collaborators are listed in Supplementary Table 1). Study quality and risk of bias were critically appraised based on the scheme suggested by the Cochrane collaboration ("Tool to Assess Risk of Bias in Cohort Studies"; available at: http://methods.cochrane.org/sites/methods.cochrane.org.bias) and…”

Anticoagulants, Reperfusion Therapy, and Outcomes in Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation ― A Single-Center, 6-Year Experience of 546 Consecutive Patients ―

“…15,16 However, the relationships between prior DOAC treatment and initial stroke severity, as well as functional outcomes, have not been fully investigated. 17,18 The present study showed that DOAC medication prior to the event was independently associated with mild or nonsevere stroke on admission. However, discharge NIHSS and mRS scores did not differ among those with prior OAC use.…”

“…10 Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score on admission. Initial stroke severity was defined as mild (NIHSS score 0-9), moderate (NIHSS score [10][11][12][13][14][15][16][17][18][19], or severe (NIHSS score ≥20). Functional outcomes were assessed using the modified Rankin scale (mRS) score and NIHSS score at the time of discharge.…”

Baseline Characteristics of Elderly Japanese Patients Aged ≥75 Years With Non-Valvular Atrial Fibrillation and a History of Stroke ― ANAFIE Registry ―

“…The risk of intracranial hemorrhage and mortality has been shown to be significantly lower with DOAC than with warfarin both in randomized trials 26 and in post-marketing registries. 27,28 Due to concerns about bleeding and mortality, physicians are often cautious about prescribing warfarin for elderly patients with NVAF. In the ANAFIE Registry, the high use of anticoagulation therapy than previously reported can be attributed to the large number of NVAF patients receiving DOAC, although most elderly patients with NVAF received the lower of the 2 recommended doses for each DOAC.…”