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Comparing Efficacy and Safety Between Patients With Atrial Fibrillation Taking Direct Oral Anticoagulants or Warfarin After Direct Oral Anticoagulant Failure.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2023 Dec 05; Vol. 12 (23), pp. e029979. Date of Electronic Publication: 2023 Dec 01. - Publication Year :
- 2023
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Abstract
- Background: An increased risk of recurrent stroke is noted in patients with atrial fibrillation despite direct oral anticoagulant (DOAC) use. We investigated the efficacy and safety of treatment with each of 4 different DOACs or warfarin after DOAC failure.<br />Methods and Results: We retrospectively analyzed patients with atrial fibrillation with ischemic stroke despite DOAC treatment between January 2002 and December 2016. The different outcomes of patients with DOAC failure were compared, including recurrent ischemic stroke, major cardiovascular events, intracranial hemorrhage and subarachnoid hemorrhage, mortality, and net composite outcomes according to switching to different DOACs or vitamin K antagonist after index ischemic stroke. We identified 3759 patients with DOAC failure. A total of 84 patients experienced recurrent ischemic stroke after switching to different oral anticoagulants, with a total follow-up time of 14 years. Using the vitamin K antagonist group as a reference, switching to any of the 4 DOACs was associated with a 69% to 77% reduced risk of major cardiovascular events (adjusted hazard ratio [aHR], 0.25 [95% CI, 0.16-0.39] for apixaban, 0.23 [95% CI, 0.14-0.37] for dabigatran, 0.23 [95% CI, 0.09-0.60] for edoxaban, and 0.31 [95% CI, 0.21-0.45] for rivaroxaban), and a 69% to 83% reduced risk of net composite outcomes (aHR, 0.25 [95% CI, 0.18-0.35] for apixaban, 0.17 [95% CI, 0.11-0.25] for dabigatran, 0.31 [95% CI, 0.17-0.56] for edoxaban, and 0.31 [95% CI, 0.23-0.41] for rivaroxaban).<br />Conclusions: In Asian patients with DOAC failure, continuing DOACs after index stroke was associated with fewer undesirable outcomes than switching to a vitamin K antagonist. Alternative pharmacologic and nonpharmacologic strategies warrant investigation.
- Subjects :
- Humans
Warfarin adverse effects
Rivaroxaban adverse effects
Dabigatran adverse effects
Retrospective Studies
Anticoagulants adverse effects
Vitamin K
Administration, Oral
Atrial Fibrillation complications
Atrial Fibrillation drug therapy
Atrial Fibrillation chemically induced
Stroke prevention & control
Stroke complications
Ischemic Stroke drug therapy
Subarachnoid Hemorrhage complications
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 12
- Issue :
- 23
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 38038171
- Full Text :
- https://doi.org/10.1161/JAHA.123.029979