BACKGROUND: We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry in Japan.Methods and Results: NVAF patients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS2and discharge modified Rankin Scale scores than warfarin users (P<0.0001 each). Incidences of stroke/systemic embolism (adjusted hazard ratio, 1.07; 95% CI, 0.66-1.72), all ischemic events (1.13; 0.72-1.75), and ischemic stroke/TIA (1.58; 0.95-2.62) were similar between groups. Risks of intracranial hemorrhage (0.32; 0.09-0.97) and death (0.41; 0.26-0.63) were significantly lower for DOAC users. Infection was the leading cause of death, accounting for 40% of deaths among warfarin users. CONCLUSIONS: 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.
BACKGROUND: We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry in Japan.Methods and Results:NVAFpatients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS2and discharge modified Rankin Scale scores than warfarin users (P<0.0001 each). Incidences of stroke/systemic embolism (adjusted hazard ratio, 1.07; 95% CI, 0.66-1.72), all ischemic events (1.13; 0.72-1.75), and ischemic stroke/TIA (1.58; 0.95-2.62) were similar between groups. Risks of intracranial hemorrhage (0.32; 0.09-0.97) and death (0.41; 0.26-0.63) were significantly lower for DOAC users. Infection was the leading cause of death, accounting for 40% of deaths among warfarin users. CONCLUSIONS:Stroke/TIApatients 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.
Authors: Alexandros A Polymeris; Annaelle Zietz; Fabian Schaub; Louisa Meya; Christopher Traenka; Sebastian Thilemann; Benjamin Wagner; Lisa Hert; Valerian L Altersberger; David J Seiffge; Flurina Lyrer; Tolga Dittrich; Ines Piot; Josefin Kaufmann; Lea Barone; Ludvig Dahlheim; Sophie Flammer; Nikolaos S Avramiotis; Nils Peters; Gian Marco De Marchis; Leo H Bonati; Henrik Gensicke; Stefan T Engelter; Philippe A Lyrer Journal: Eur Stroke J Date: 2022-05-10
Authors: David J Seiffge; Gian Marco De Marchis; Masatoshi Koga; Maurizio Paciaroni; Duncan Wilson; Manuel Cappellari; Kosmas Macha Md; Georgios Tsivgoulis; Gareth Ambler; Shoji Arihiro; Leo H Bonati; Bruno Bonetti; Bernd Kallmünzer; Keith W Muir; Paolo Bovi; Henrik Gensicke; Manabu Inoue; Stefan Schwab; Shadi Yaghi; Martin M Brown; Philippe Lyrer; Masahito Takagi; Monica Acciarrese; Hans Rolf Jager; Alexandros A Polymeris; Kazunori Toyoda; Michele Venti; Christopher Traenka; Hiroshi Yamagami; Andrea Alberti; Sohei Yoshimura; Valeria Caso; Stefan T Engelter; David J Werring Journal: Ann Neurol Date: 2020-02-12 Impact factor: 10.422
Authors: David J Seiffge; Maurizio Paciaroni; Duncan Wilson; Masatoshi Koga; Kosmas Macha; Manuel Cappellari; Sabine Schaedelin; Clare Shakeshaft; Masahito Takagi; Georgios Tsivgoulis; Bruno Bonetti; Bernd Kallmünzer; Shoji Arihiro; Andrea Alberti; Alexandros A Polymeris; Gareth Ambler; Sohei Yoshimura; Michele Venti; Leo H Bonati; Keith W Muir; Hiroshi Yamagami; Sebastian Thilemann; Riccardo Altavilla; Nils Peters; Manabu Inoue; Tobias Bobinger; Giancarlo Agnelli; Martin M Brown; Shoichiro Sato; Monica Acciarresi; Hans Rolf Jager; Paolo Bovi; Stefan Schwab; Philippe Lyrer; Valeria Caso; Kazunori Toyoda; David J Werring; Stefan T Engelter; Gian Marco De Marchis Journal: Ann Neurol Date: 2019-04-30 Impact factor: 10.422
Authors: Duncan Wilson; Gareth Ambler; Keon-Joo Lee; Jae-Sung Lim; Masayuki Shiozawa; Masatoshi Koga; Linxin Li; Caroline Lovelock; Hugues Chabriat; Michael Hennerici; Yuen Kwun Wong; Henry Ka Fung Mak; Luis Prats-Sánchez; Alejandro Martínez-Domeño; Shigeru Inamura; Kazuhisa Yoshifuji; Ethem Murat Arsava; Solveig Horstmann; Jan Purrucker; Bonnie Yin Ka Lam; Adrian Wong; Young Dae Kim; Tae-Jin Song; Maarten Schrooten; Robin Lemmens; Sebastian Eppinger; Thomas Gattringer; Ender Uysal; Zeynep Tanriverdi; Natan M Bornstein; Einor Ben Assayag; Hen Hallevi; Jun Tanaka; Hideo Hara; Shelagh B Coutts; Lisa Hert; Alexandros Polymeris; David J Seiffge; Philippe Lyrer; Ale Algra; Jaap Kappelle; Rustam Al-Shahi Salman; Hans R Jäger; Gregory Y H Lip; Heinrich P Mattle; Leonidas D Panos; Jean-Louis Mas; Laurence Legrand; Christopher Karayiannis; Thanh Phan; Sarah Gunkel; Nicolas Christ; Jill Abrigo; Thomas Leung; Winnie Chu; Francesca Chappell; Stephen Makin; Derek Hayden; David J Williams; M Eline Kooi; Dianne H K van Dam-Nolen; Carmen Barbato; Simone Browning; Kim Wiegertjes; Anil M Tuladhar; Noortje Maaijwee; Christine Guevarra; Chathuri Yatawara; Anne-Marie Mendyk; Christine Delmaire; Sebastian Köhler; Robert van Oostenbrugge; Ying Zhou; Chao Xu; Saima Hilal; Bibek Gyanwali; Christopher Chen; Min Lou; Julie Staals; Régis Bordet; Nagaendran Kandiah; Frank-Erik de Leeuw; Robert Simister; Aad van der Lugt; Peter J Kelly; Joanna M Wardlaw; Yannie Soo; Felix Fluri; Velandai Srikanth; David Calvet; Simon Jung; Vincent I H Kwa; Stefan T Engelter; Nils Peters; Eric E Smith; Yusuke Yakushiji; Dilek Necioglu Orken; Franz Fazekas; Vincent Thijs; Ji Hoe Heo; Vincent Mok; Roland Veltkamp; Hakan Ay; Toshio Imaizumi; Beatriz Gomez-Anson; Kui Kai Lau; Eric Jouvent; Peter M Rothwell; Kazunori Toyoda; Hee-Joon Bae; Joan Marti-Fabregas; David J Werring Journal: Lancet Neurol Date: 2019-05-23 Impact factor: 59.935