Author + information
- Partha Sardar,
- Saurav Chatterjee,
- Wen-Chih Wu,
- Edgar Lichstein,
- Joydeep Ghosh,
- Shamik Aikat and
- Debabrata Mukherjee
Patients with Atrial Fibrillation (AF) and prior stroke are classified as high risk. A systematic review and meta-analysis was performed to compare the efficacy and safety of New Oral Anticoagulants (NOACs) to warfarin in patients with AF and previous stroke or transient ischemic attack (TIA).
Three randomized controlled trials (RCTs), including total 14527 patients, comparing NOACs (apixaban, dabigatran and rivaroxaban) with warfarin were included in the analysis. Primary efficacy endpoint was ischemic stroke, and primary safety endpoint was hemorrhagic stroke. Random-effects models were used to pool efficacy and safety data across RCTs. RevMan and Stata software were used for direct and indirect comparisons, respectively.
In patients with AF and previous stroke or TIA, effects of NOACs were not statistically different from that of warfarin, in reduction of stroke. Randomization to NOACs was associated with a significantly lower risk of hemorrhagic stroke. There were no major differences in efficacy between apixaban, dabigatran (110 mg BID and 150 mg BID) and rivaroxaban. Major bleeding was significantly lower with apixaban and dabigatran (110 mgBID) compared with dabigatran (150 mgBID) and rivaroxaban.
NOACs may not be more effective than warfarin in the secondary prevention of ischemic stroke in patients with a prior history of cerebrovascular ischemia, but have a lower risk of hemorrhagic stroke.
Oral Contributions West, Room 3009
Sunday, March 10, 2013, 9:00 a.m.-9:15 a.m.
Session Title: Joint Session of the Heart Rhythm Society and the American College of Cardiology: Anticoagulation in Atrial Fibrillation -Management Questions with New Anticoagulants
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 914-7
- 2013 American College of Cardiology Foundation