Long-Term Anticoagulation in Secondary Ischemic Stroke Prevention: The Prospective Multicenter RESTAIC Registry

Gutiérrez-Zúñiga, Raquel; Rigual, Ricardo; Torres-Iglesias, Gabriel; Sánchez-Velasco, Sara; Leciñana, María Alonso de; Masjuán, Jaime; Velasco, Rodrigo Álvarez; Navas, Inmaculada; Izquierdo-Esteban, Laura; Fernández-Ferro, José; Rodríguez‐Pardo, Jorge; Ruíz-Ares, Gerardo; Zapata-Wainberg, Gustavo; Fuentes, Blanca; Díez‐Tejedor, Exuperio

doi:10.3389/fneur.2020.575634

Cited by 6 publications

(5 citation statements)

References 63 publications

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“…In reality, many Asian doctors have stated that because of the risk of bleeding complications, more people are being prescribed low-dose NOACs than they are eligible for, resulting in 18.8% of the Asian population being undertreated. 33,34 Even in our study, more than half (53.8%) of the 14,843 NOAC users used low-dose NOACs. However, low-dose NOAC users were inferior to standard-dose NOAC users in terms of both secondary prevention effectiveness and safety, and there was no signi cant difference when compared with warfarin users.…”

Section: Discussionmentioning

confidence: 54%

Outcomes of Non-Vitamin K Oral Anticoagulants for Secondary Prevention in Ischemic Stroke with Atrial Fibrillation

Nam,

Kwon,

Lee

et al. 2023

Preprint

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Previous studies have rarely investigated the role of non-vitamin K oral anticoagulants (NOAC) and warfarin in the secondary prevention of ischemic stroke patients with nonvalvular atrial fibrillation (NVAF). In this study, we compared the effectiveness and safety of NOAC and warfarin for secondary prevention in Korean ischemic stroke patients with NVAF. Based on the Korean National Health Insurance Service Database, this study included 21,064 oral anticoagulants-naïve acute ischemic stroke patients with NVAF between July 2015 and June 2019. The main study outcomes included ischemic stroke, systemic embolism, major bleeding, and death. During the observational periods, NOAC users had a significantly decreased risk of ischemic stroke + systemic embolism (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.78–0.95), ischemic stroke (aHR, 0.89; 95% CI, 0.81–0.99), major bleeding (aHR, 0.78; 95% CI, 0.68–0.89), and all-cause death (aHR, 0.87; 95% CI, 0.81–0.93). Standard-dose NOAC users had a lower risk of ischemic stroke, systemic embolism, and major bleeding events than warfarin users. In contrast, low-dose NOAC users did not differ in risk from warfarin users for all outcomes. In conclusion, NOACs were associated with a lower risk of secondary thromboembolic events and bleeding complications in Korean ischemic stroke patients with NVAF than warfarin.

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Section: Discussionmentioning

confidence: 54%

Outcomes of Non-Vitamin K Oral Anticoagulants for Secondary Prevention in Ischemic Stroke with Atrial Fibrillation

Nam,

Kwon,

Lee

et al. 2023

Preprint

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“…Consequently, for Asians, the use of NOAC, especially low-dose NOAC, seems to have merit. In reality, many Asian doctors have stated that because of the risk of bleeding complications, more people are being prescribed low-dose NOACs than they are eligible for, resulting in 18.8% of the Asian population being undertreated 33 , 34 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of non-vitamin K oral anticoagulants for secondary prevention in ischemic stroke with atrial fibrillation

Nam,

Kwon,

Lee

et al. 2024

Sci Rep

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Previous studies have rarely investigated the role of non-vitamin K oral anticoagulants (NOAC) and warfarin in the secondary prevention of ischemic stroke patients with nonvalvular atrial fibrillation (NVAF). In this study, we compared the effectiveness and safety of NOAC and warfarin for secondary prevention in Korean ischemic stroke patients with NVAF. Based on the Korean National Health Insurance Service Database, this study included 21,064 oral anticoagulants-naïve acute ischemic stroke patients with NVAF between July 2015 and June 2019. The main study outcomes included ischemic stroke, systemic embolism, major bleeding, and death. During the observational periods, NOAC users had a significantly decreased risk of ischemic stroke + systemic embolism (adjusted hazard ratio [aHR] 0.86; 95% confidence interval [CI] 0.78–0.95), ischemic stroke (aHR 0.89; 95% CI 0.81–0.99), major bleeding (aHR 0.78; 95% CI 0.68–0.89), and all-cause death (aHR 0.87; 95% CI 0.81–0.93). Standard-dose NOAC users had a lower risk of ischemic stroke, systemic embolism, and major bleeding events than warfarin users. In contrast, low-dose NOAC users did not differ in risk from warfarin users for all outcomes. In conclusion, NOACs were associated with a lower risk of secondary thromboembolic events and bleeding complications in Korean ischemic stroke patients with NVAF than warfarin.

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“…Nevertheless, although gradually decreasing in frequency, 11%–53% of patients with newly diagnosed NVAF are still started on VKAs. Switching patterns under anticoagulant therapy have been characterized on several occasions and the most prevalent is VKAs to DOACs with rates of 10.3%–72.7%, mainly associated with patient ease of use, INR instability, adverse effects, primarily cerebral hemorrhage and extracranial bleeding, challenges with access to blood drawing laboratories, need for frequent blood draws, need for any dose changes, concerns regarding patient adherence, female sex and prior stroke depending on the study 49–52 …”

Section: Discussionmentioning

confidence: 99%

“…mainly associated with patient ease of use, INR instability, adverse effects, primarily cerebral hemorrhage and extracranial bleeding, challenges with access to blood drawing laboratories, need for frequent blood draws, need for any dose changes, concerns regarding patient adherence, female sex and prior stroke depending on the study [49][50][51][52]. …”

mentioning

confidence: 99%

Risk of ischemic stroke associated with direct oral anticoagulants discontinuation on patients with non‐valvular atrial fibrillation

Álvaro Thomsen,

Mesa Guadalupe,

Huerta

et al. 2023

Pharmacoepidemiology and Drug

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IntroductionAlthough direct oral anticoagulants' (DOACs) prescriptions have experienced immense growth in the last decade, the proportion of discontinuers is still common yielding an increased risk of ischemic stroke (IS) onset.AimsWe aimed to estimate the association between DOACs discontinuation and risk of IS among patients with non‐valvular atrial fibrillation (NVAF).MethodsWe used data from a cohort of new DOACs users, followed patients from the first DOAC prescription date up to IS (index date) and conducted a nested case–control analysis using conditional logistic regression. Adjusted odds ratios, 95% confidence intervals were calculated for discontinuation of DOACs (current use compared with past use). The latter, subdivided among those stopping treatment 3 to 2 months and 6 and 3 months prior to index date. The effect of naïve current users against IS onset compared with non‐naïve current users was also evaluated.ResultsDOACs discontinuation showed an OR of IS of 1.47 (95% CI: 1.02–2.12); estimates were 2.51 (95% CI: 1.84–3.42) for whom discontinued treatment within months 3 and 2 and 1.43 (95% CI: 0.96–2.13) for those between months 6 and 3 prior to index date. Analyzing DOACs individually, risk of IS associated with past users compared with current users: 1.98 (95% CI: 1.25–3.12) for apixaban, 1.38 (95% CI: 0.40–4.72) for edoxaban, 1.98 (95% CI: 1.24–2.65) for dabigatran and 1.87 (95% CI: 1.26–2.76) for rivaroxaban. Similar results were found when stratified by naïve and non‐naïve users.ConclusionsDOACs' discontinuation is associated with higher risk of IS, especially in the second and third months following interruption.

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Long-Term Anticoagulation in Secondary Ischemic Stroke Prevention: The Prospective Multicenter RESTAIC Registry

Cited by 6 publications

References 63 publications

Outcomes of Non-Vitamin K Oral Anticoagulants for Secondary Prevention in Ischemic Stroke with Atrial Fibrillation

Outcomes of Non-Vitamin K Oral Anticoagulants for Secondary Prevention in Ischemic Stroke with Atrial Fibrillation

Outcomes of non-vitamin K oral anticoagulants for secondary prevention in ischemic stroke with atrial fibrillation

Risk of ischemic stroke associated with direct oral anticoagulants discontinuation on patients with non‐valvular atrial fibrillation

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