Prophylactic anticoagulation in sinus rhythm for stroke prevention in cardiovascular disease: contemporary meta-analysis of large randomized trials

Multiple CVDs can promote thrombogenic state even in the absence of AF, which may cause ischaemic stroke. This meta-analysis of 89 383 patients with mixed CVD in sinus rhythm compares reduction in ischaemic stroke rate with the use NOACs in comparison to placebo or antiplatelet drugs. We found a significant reduction (26%, OR 0.74 95% CI 0.62—0.87) in stroke rate but there was harm from major bleeding and intracranial haemorrhage with both primary- and mini-dose of NOACs. Future studies should test safety of NOACs in highest stroke risk patients such as those with atrial cardiopathy in sinus rhythm.