- Older adults hospitalized for ischemic stroke who have Afib achieve better long-term outcomes when they receive direct oral anticoagulants (DOACs) instead of warfarin at discharge.
Why this matters
- Guidelines recommend DOACs over warfarin, but real-world data are limited.
- 34.7% of patients discharged with DOACs, 65.3% with warfarin.
- Patients discharged with DOACs had:
- More time at home during first year (mean, 287.2 vs 263.0 days; P<.001>
- Lower risk for major adverse cardiovascular events (adjusted HR [aHR], 0.89; P<.001>
- Death (aHR, 0.88; P
- All-cause readmission (aHR, 0.93; P=.003),
- Cardiovascular readmission (aHR, 0.92; P=.02),
- Hemorrhagic stroke (aHR, 0.69; P=.02),
- Hospitalizations for bleeding (aHR, 0.89; P=.009),
- Retrospective cohort study of 11,662 patients 65 years or older who had Afib, were anticoagulation-naive, were discharged after acute ischemic stroke from Get With The Guidelines-Stroke–associated hospitals (PROSPER Study).
- Main outcomes: home time and major adverse cardiovascular events (assessed from linked Medicare claims).
- Funding: Patient-Centered Outcomes Research Institute; American Heart Association/American Stroke Association; Medtronic; others.
- Residual and unmeasured confounding, and selection bias.
- Unclear generalizability.
- Analyses did not look at individual DOACs.