Impact of non-vitamin K oral anticoagulants vs warfarin on stroke severity

Takeaway

• In phase 3 trials of non-vitamin K oral anticoagulants (NOACs), for prevention of stroke in the setting of non-valvular atrial fibrillation (Afib), NOACs use was associated with a reduced risk for fatal, disabling or non-disabling stroke compared with warfarin use.

Why this matters

• Findings suggest that appropriately prescribed NOACs may be associated with greater reduction in stroke severity compared with warfarin.

Study design

• Five phase 3 randomised controlled trials (RCTs) involving 75,512 participants met eligibility criteria after a search on PubMed, MEDLINE, EMBASE, and clinicaltrials.gov.
• Funding: None.

Key results

• NOACs were significantly superior to warfarin in reducing the risk for:
  • fatal or disabling stroke (OR, 0.77; 95% CI, 0.66-0.89; P=.0004) and
  • non-disabling stroke (OR, 0.85; 95% CI, 0.73-0.98; P=.03).
• No significant difference was observed in case-fatality stroke between NOAC and warfarin group (OR, 0.90; 95% CI, 0.75-1.13; P=.35).
• NOAC group had a lower incidence of intracranial haemorrhage compared with the warfarin group (39.09% vs 60.91%).
• The incidence of ischaemic events was higher in NOAC vs warfarin group (61.87% vs 38.13%).

Limitations

• Study did not report stroke severity and associated net clinical benefit.