DOACs better than warfarin in ischemic stroke survivors with Afib

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

  • International 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.


  • 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.


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

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.