DOACs better than warfarin in ischemic stroke survivors with Afib

  • Xian Y & al.
  • JAMA Neurol
  • 22 Jul 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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>
  • Patients receiving DOACs also had lower risks for:
    • 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),
  • Patients receiving DOACs had higher risk for gastrointestinal bleeding (aHR, 1.14; P=.03).

Study design

  • 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.

Limitations

  • Residual and unmeasured confounding, and selection bias.
  • Unclear generalizability.
  • Analyses did not look at individual DOACs.

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