Abstract Details

Title Direct oral anticoagulants versus Vitamin K antagonists after a recent ischemic stroke or TIA– a pooled individual patient data analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S35 - Stroke Prevention Strategies (2:06 PM-2:17 PM)

Poster/Presentation
Number 007

Background Risks and benefits of early administration of DOAC after a recent ischemic stroke or TIA in patients with AF are poorly understood.

Objective We compared clinical outcomes after treatment with direct anticoagulants (DOAC) and Vitamin-K antagonists (VKA) among patients with a recent ischemic stroke or TIA and atrial fibrillation (AF).

Design/Methods We conducted an individual patient data analysis of 7 prospective cohort studies. We included patients with AF and an ischemic stroke or TIA within 3 months before starting oral anticoagulation. We analyzed the association between type of anticoagulation (DOAC vs. VKA) with the composite primary endpoint (recurrent ischemic stroke [AIS], intracranial hemorrhage [ICH], or mortality) using mixed effects Cox proportional hazards regression models and the Fine and Gray model for competing risks; we calculated adjusted hazard ratios (HR) with 95% confidence intervals (95% CI).

Results We included 4912 patients (median age 78 years [IQR 71-84]; 2331 [47.5%] women) of whom 4739 (96.5%) had ischemic stroke as the index event (median NIHSS at onset 5 [IQR 2-12]); 2256 (45.9%) patients received VKA and 2656 (54.1%) DOAC. The median time from index event to starting oral anticoagulation was 5 days (IQR 2-14) for VKA and 5 days (IQR 2-11) for DOAC (p=0.53). There were 262 AIS (4.4%/year), 71 ICH (1.2%/year) and 439 deaths (7.4%/year) during the total follow-up of 5970 patient-years. Compared to VKA, DOAC treatment was associated with reduced risks of the composite endpoint (HR 0.81, 95%CI 0.66-0.98, p=0.03) and ICH (HR 0.42, 95%CI 0.25-0.72, p<0.01); we found no differences for the risk of recurrent AIS (HR 0.92, 95%CI 0.70-1.20, p=0.53) and mortality (HR 0.84, 95%CI 0.68-1.04, p=0.11).

Conclusions DOAC treatment commenced after a median of 5 days after cerebral ischemia related to AF was associated with reduced risk of poor clinical outcomes compared to VKA, mainly due to a lower risk of ICH.

Authors/Disclosures
Gian Marco De Marchis, MD (University Hospital Basel) PRESENTER	No disclosure on file
	No disclosure on file
Maurizio Paciaroni, MD (Santa Maria Della Misericordia)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sabine Schaedelin	Sabine Schaedelin has nothing to disclose.
	No disclosure on file
Masahito Takagi, MD, PhD (Morishita Clinic)	No disclosure on file
Georgios Tsivgoulis, MD, FAAN (NEURODIAGNOSTICS AND NEUROTHERAPEUTICS PC)	Dr. Tsivgoulis has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Andrea Alberti	No disclosure on file
	No disclosure on file
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	No disclosure on file
Leo Bonati, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
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	No disclosure on file
Nils Peters	No disclosure on file
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	No disclosure on file
Stefan Schwab, MD (U. of Erlangen, Dept. of Neurology)	Dr. Schwab has nothing to disclose.
Philippe A. Lyrer, MD (University Hospital Basel)	No disclosure on file
Valeria Caso, MD, PhD (Santa Maria Della Misericordia)	Dr. Caso has nothing to disclose.
Kazunori Toyoda, MD, PhD (National Cerebral and Cardiovascular Center)	No disclosure on file
	No disclosure on file
Stefan T. Engelter, MD (University Hospital Neurology Clinic)	No disclosure on file

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