Kandavadivu Umashankar1, Marco Mammi2,3, Ebtissam Badawoud1, Yuzhi Tang1, Mengqi Zhou1, Jorge C Borges4, Aaron Liew5, Mattia Migliore1, Rania A Mekary6,7,8. 1. School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA. 2. Neurosurgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy. 3. Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 4. Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center (TTUHSC), Paul L. Foster School of Medicine, El Paso, TX, USA. 5. Portiuncula University Hospital and National University of Ireland Galway (NUIG), Galway, Ireland. 6. School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA. rania.mekary@mcphs.edu. 7. Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. rania.mekary@mcphs.edu. 8. Research Faculty, Harvard Medical School, Brigham and Women's Hospital (CNOC), 179 Longwood Avenue, Boston, MA, 02115, USA. rania.mekary@mcphs.edu.
Abstract
BACKGROUND: The purpose of this meta-analysis was to compare efficacy and safety of direct oral anticoagulants (DOACs) to warfarin for secondary stroke prevention among adult patients with atrial fibrillation and prior stroke. METHODS: Major repositories were screened for randomized controlled trials (RCTs), RCT subgroups, and observational studies (OBSs, divided in claims and non-claims). Occurrences of ischemic stroke or transient ischemic attack, systemic embolism, all-cause mortality, intracranial hemorrhage (ICH), and major bleeding were outcomes of interest. Hazard ratios (HRs) and their confidence intervals (95%CIs) were pooled using random-effects models for each study design. Claims studies were analyzed separately from non-claims, while RCT subgroups were grouped with OBSs (non-claims) as the randomization was broken. RESULTS: Of 8647 articles, 20 were included (one RCT, six RCT subgroups, nine claims, and four non-claims). Comparing DOACs to warfarin, pooled HRs (95%CI) were consistently in favor of DOACs although some did not reach statistical significance: for ischemic stroke, 0.84 (0.66-1.07) in claims; 0.90 (0.77-1.06) in non-claims and RCT subgroups; for systemic embolism, 0.77 (0.62-0.96) in claims; 0.86 (0.77-0.96) in non-claims and RCT subgroups; for all-cause mortality, 0.57 (0.33-0.99) in claims; 0.87 (0.79-0.96) in non-claims and RCT subgroups; for ICH, 0.72 (0.39-1.33) in claims; 0.51 (0.38-0.67) in non-claims and RCT subgroups; and for major bleeding, 0.86 (0.71-1.03) in claims; 0.90 (0.76-1.08) for non-claims and RCT subgroups. CONCLUSION: DOACs were associated with better efficacy and safety profiles than warfarin in atrial fibrillation patients with prior stroke, more specifically a lower risk of systemic embolism, all-cause mortality, and ICH.
BACKGROUND: The purpose of this meta-analysis was to compare efficacy and safety of direct oral anticoagulants (DOACs) to warfarin for secondary stroke prevention among adult patients with atrial fibrillation and prior stroke. METHODS: Major repositories were screened for randomized controlled trials (RCTs), RCT subgroups, and observational studies (OBSs, divided in claims and non-claims). Occurrences of ischemic stroke or transient ischemic attack, systemic embolism, all-cause mortality, intracranial hemorrhage (ICH), and major bleeding were outcomes of interest. Hazard ratios (HRs) and their confidence intervals (95%CIs) were pooled using random-effects models for each study design. Claims studies were analyzed separately from non-claims, while RCT subgroups were grouped with OBSs (non-claims) as the randomization was broken. RESULTS: Of 8647 articles, 20 were included (one RCT, six RCT subgroups, nine claims, and four non-claims). Comparing DOACs to warfarin, pooled HRs (95%CI) were consistently in favor of DOACs although some did not reach statistical significance: for ischemic stroke, 0.84 (0.66-1.07) in claims; 0.90 (0.77-1.06) in non-claims and RCT subgroups; for systemic embolism, 0.77 (0.62-0.96) in claims; 0.86 (0.77-0.96) in non-claims and RCT subgroups; for all-cause mortality, 0.57 (0.33-0.99) in claims; 0.87 (0.79-0.96) in non-claims and RCT subgroups; for ICH, 0.72 (0.39-1.33) in claims; 0.51 (0.38-0.67) in non-claims and RCT subgroups; and for major bleeding, 0.86 (0.71-1.03) in claims; 0.90 (0.76-1.08) for non-claims and RCT subgroups. CONCLUSION: DOACs were associated with better efficacy and safety profiles than warfarin in atrial fibrillation patients with prior stroke, more specifically a lower risk of systemic embolism, all-cause mortality, and ICH.
Authors: Abdulaali R Almutairi; Lili Zhou; Walid F Gellad; Jeannie K Lee; Marion K Slack; Jennifer R Martin; Wei-Hsuan Lo-Ciganic Journal: Clin Ther Date: 2017-06-28 Impact factor: 3.393
Authors: Yu Tung Lo; Michelle Lim-Watson; Yookyung Seo; Noemi Fluetsch; Moudi M Alasmari; Mona Y Alsheikh; Nayan Lamba; Timothy R Smith; Linda S Aglio; Rania A Mekary Journal: World Neurosurg Date: 2020-06-19 Impact factor: 2.104
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Authors: Raghavendra Charan P Makam; David C Hoaglin; David D McManus; Victoria Wang; Joel M Gore; Frederick A Spencer; Richeek Pradhan; Hoang Tran; Hong Yu; Robert J Goldberg Journal: PLoS One Date: 2018-05-24 Impact factor: 3.240