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Cited by 152Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

Nonvitamin-K-Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ntaios, George, Papavasileiou, Vasileios, Diener, Hans-Christoph, Makaritsis, Konstantinos, Michel, Patrik·2012·Stroke
DOI 10.1161/strokeaha.112.673558
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Abstract

BACKGROUND AND PURPOSE: To assess whether the combined analysis of all phase III trials of nonvitamin-K-antagonist (non-VKA) oral anticoagulants in patients with atrial fibrillation and previous stroke or transient ischemic attack shows a significant difference in efficacy or safety compared with warfarin. METHODS: We searched PubMed until May 31, 2012, for randomized clinical trials using the following search items: atrial fibrillation, anticoagulation, warfarin, and previous stroke or transient ischemic attack. Studies had to be phase III trials in atrial fibrillation patients comparing warfarin with a non-VKA currently on the market or with the intention to be brought to the market in North America or Europe. Analysis was performed on intention-to-treat basis. A fixed-effects model was used as more appropriate than a random-effects model when combining a small number of studies. RESULTS: Among 47 potentially eligible articles, 3 were included in the meta-analysis. In 14 527 patients, non-VKAs were associated with a significant reduction of stroke/systemic embolism (odds ratios, 0.85 [95% CI, 074-0.99]; relative risk reduction, 14%; absolute risk reduction, 0.7%; number needed to treat, 134 over 1.8-2.0 years) compared with warfarin. Non-VKAs were also associated with a significant reduction of major bleeding compared with warfarin (odds ratios, 0.86 [95% CI, 075-0.99]; relative risk reduction, 13%; absolute risk reduction, 0.8%; number needed to treat, 125), mainly driven by the significant reduction of hemorrhagic stroke (odds ratios, 0.44 [95% CI, 032-0.62]; relative risk reduction, 57.9%; absolute risk reduction, 0.7%; number needed to treat, 139). CONCLUSIONS: In the context of the significant limitations of combining the results of disparate trials of different agents, non-VKAs seem to be associated with a significant reduction in rates of stroke or systemic embolism, hemorrhagic stroke, and major bleeding when compared with warfarin in patients with previous stroke or transient ischemic attack.

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Crossref · 10.1161/strokeaha.112.673558

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  • NOACs seem to convey slightly better outcomes than VKAs in AF patients who survived a stroke, mainly driven by fewer intracranial haemorrhages and haemorrhagic strokes (OR 0.44, 95% CI 0.32-0.62).

    “NOACs seem to convey slightly better outcomes, mainly driven by fewer intracranial haemorrhages and haemorrhagic strokes (OR 0.44, 95% CI 0.32-0.62).482”

    From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [482]

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Authors
Ntaios, G., Papavasileiou, V., Diener, H.-C., Makaritsis, K., & Michel, P.
Affiliations
University of Thessaly (GR)
ORCID
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2012-12
Volume
43
Issue
12
Pages
3298-3304
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/strokeaha.112.673558
OpenAlex
W2119721842
Cited by
152
References
21
Citations by year
2026: 3 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 7 · 2021: 13 · 2020: 15 · 2019: 7 · 2018: 13 · 2017: 14 · 2016: 21 · 2015: 18 · 2014: 19 · 2013: 12
FWCI
10.09
Type
journal article
Language
en
Open access
closed
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
  • Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
  • University of Thessaly Institutional Repository (University of Thessaly) (submittedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords
direct oral anticoagulants, atrial fibrillation, warfarin, stroke prevention, transient ischemic attack, stroke and systemic embolism, major bleeding, hemorrhagic stroke, anticoagulant efficacy and safety
MeSH terms
Administration, Oral, Anticoagulants, Atrial Fibrillation, Azetidines, Benzylamines, Ischemic Attack, Transient, Humans, Vitamin K, Warfarin, Randomized Controlled Trials as Topic, Clinical Trials, Phase III as Topic, Stroke

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