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Two-Year Outcomes of Anticoagulation for Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation - SAMURAI-NVAF Study.
- Source :
-
Circulation journal : official journal of the Japanese Circulation Society [Circ J] 2018 Jun 25; Vol. 82 (7), pp. 1935-1942. Date of Electronic Publication: 2018 Jun 01. - Publication Year :
- 2018
-
Abstract
- Background: We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry in Japan.Methods and Results:NVAF patients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS <subscript>2</subscript> and discharge modified Rankin Scale scores than warfarin users (P<0.0001 each). Incidences of stroke/systemic embolism (adjusted hazard ratio, 1.07; 95% CI, 0.66-1.72), all ischemic events (1.13; 0.72-1.75), and ischemic stroke/TIA (1.58; 0.95-2.62) were similar between groups. Risks of intracranial hemorrhage (0.32; 0.09-0.97) and death (0.41; 0.26-0.63) were significantly lower for DOAC users. Infection was the leading cause of death, accounting for 40% of deaths among warfarin users.<br />Conclusions: Stroke/TIA patients receiving DOACs for secondary prevention were younger and had lower stroke severity and risk indices than those receiving warfarin. Estimated cumulative incidences of stroke and systemic embolism within 2 years were similar between warfarin and DOACs users, but those of death and intracranial hemorrhage were significantly lower among DOAC users.
- Subjects :
- Administration, Oral
Aged
Aged, 80 and over
Anticoagulants administration & dosage
Anticoagulants adverse effects
Brain Ischemia chemically induced
Female
Follow-Up Studies
Humans
Infections chemically induced
Ischemic Attack, Transient drug therapy
Japan
Male
Middle Aged
Prospective Studies
Registries
Survival Analysis
Treatment Outcome
Warfarin adverse effects
Warfarin therapeutic use
Anticoagulants therapeutic use
Atrial Fibrillation drug therapy
Stroke drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1347-4820
- Volume :
- 82
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Circulation journal : official journal of the Japanese Circulation Society
- Publication Type :
- Academic Journal
- Accession number :
- 29863095
- Full Text :
- https://doi.org/10.1253/circj.CJ-18-0067