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

  • Costello M & al.
  • Eur J Neurol
  • 5 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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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.