Program

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In-person registration included the full virtual experience, and virtual-only attendees will be able to tune into live in-person sessions and/or watch captured in-person sessions on-demand in addition to having a variety of virtual-only sessions to attend.

Efficacy and Safety of Direct Oral Anticoagulants (DOACS) Versus Warfarin in Atrial Fibrillation Patients with Prior Stroke: A Systematic Review and Meta-Analysis

Speaker(s)

Umashankar K1, Mammi M2, Badawoud E1, Tang Y1, Zhou M1, Borges JC3, Liew A4, Migliore M1, Mekary RA1, Gedda DUK5
1MCPHS University, Boston, MA, USA, 2Neurosurgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy, 3Paul L. Foster School of Medicine, El Paso, TX, USA, 4National University of Ireland Galway, Galway, Ireland, 5MCPHS University, Malden, MA, USA

Presentation Documents

OBJECTIVES: The purpose of this meta-analysis was to compare efficacy and safety of direct oral anticoagulants (DOACs) to warfarin for secondary stroke prevention among adult patients with atrial fibrillation and prior stroke.

METHODS: Major repositories were screened for randomized controlled trials (RCTs), RCT subgroups, and observational studies (OBSs, divided in claims and non-claims). Occurrence of ischemic stroke or transient ischemic attack, systemic embolism, all-cause mortality, intracranial hemorrhage (ICH), and major bleeding were outcomes of interest. Hazard ratios (HRs) and their confidence intervals (95%CIs) were pooled using random-effects models for each study design. Claims studies were analyzed separately from non-claims, while RCT subgroups were treated as OBSs as the randomization was broken.

RESULTS: Of 8,647 articles, 20 were included (one RCT, six RCT subgroups, nine claims, and four non-claims). Comparing DOACs to warfarin, pooled HRs (95%CI) were consistently in favor of DOACs although some did not reach statistical significance: for ischemic stroke 0.84 (0.66-1.07) in claims; 0.90 (0.77-1.06) in non-claims and RCT subgroups; for systemic embolism 0.77 (0.62-0.96) in claims; 0.86 (0.77-0.96) in non-claims and RCT subgroups; for all-cause mortality 0.57 (0.33-0.99) in claims; 0.87 (0.79-0.96) in non-claims and RCT subgroups; for ICH 0.72 (0.39-1.33) in claims; 0.51 (0.38-0.67) in non-claims and RCT subgroups; and for major bleeding 0.86 (0.71-1.03) in claims; 0.90 (0.76-1.08) for non-claims and RCT subgroups.

CONCLUSIONS: DOACs were associated with better efficacy and safety profiles than warfarin in atrial fibrillation patients with prior stroke; more specifically, a lower risk of systemic embolism, all-cause mortality, and ICH.

Code

CO55

Topic

Study Approaches

Topic Subcategory

Meta-Analysis & Indirect Comparisons

Disease

Cardiovascular Disorders, Neurological Disorders