Afib: direct oral anticoagulants vs vitamin-K antagonists after recent ischaemic stroke

  • Seiffge DJ & al.
  • Ann Neurol
  • 13 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.


  • In patients with atrial fibrillation (Afib), direct oral anticoagulants (DOAC) commenced in a median of 5 days after recent cerebral ischaemia stroke is associated with a lower risk for adverse clinical outcomes compared with vitamin-K antagonists (VKA).
  • This benefit is mainly driven by decreased risk for intracranial haemorrrhage (ICH).

Why this matters

  • DOACs are often commenced earlier in clinical practice, however, not much is known about the safety and effectiveness of this approach.

Study design

  • Individual patient data analysis of 7 prospective cohort studies involving 4912 patients with Afib and a recent cerebral ischaemia and minimum follow-up of 3 months.  
  • Primary outcomes: occurrence of the composite endpoint of recurrent AIS, ICH and mortality.
  • Funding: None disclosed.

Key results

  • Of 4912 patients, 2256 (45.9%) received VKA and 2656 (54.1%) DOAC.
  • Median time from index stroke to the start of oral anticoagulation was 5 days (interquartile range [IQR], 2-12 days) with no significant difference between patients receiving VKA and DOAC (P=.53).
  • During the total follow-up of 5970 patient-years, 262 patients had AIS (4.4%/year), 71 had ICH (1.2%/year) and 439 patients died (7.4%/year).
  • DOAC vs VKA treatment was associated with lower risks for the composite endpoint (HR, 0.82; P=.05) and ICH (HR, 0.42; P<.01>
  • Risk for recurrent AIS (HR, 0.91; P=.5) and mortality (HR, 0.83; P=.09) did not significantly differ between DOAC and VKA treatment.


  • Observational, non-randomised study
  • Choices of anticoagulation were influenced by unmeasurable factors associated with individual physician’s decision.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.