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Clinical effectiveness of direct oral anticoagulants vs warfarin in older patients with atrial fibrillation and ischemic stroke: Findings from the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

JAMA Neurology Jul 26, 2019

Xian Y, et al. - In 11,662 patients with atrial fibrillation (AF), researchers investigated the clinical efficacy of direct oral anticoagulants (DOACs; dabigatran, rivaroxaban, or apixaban) compared to warfarin following ischemic stroke. Participants in the study were aged 65 years or older, had AF, were anticoagulation naive, and were discharged from 1041 Get With The Guidelines-Stroke-associated hospitals for acute ischemic stroke between October 2011 and December 2014. Findings revealed that patients discharged while taking direct oral anticoagulants had more days at home and had lower major negative cardiovascular events, all-cause mortality, all-cause readmissions, cardiovascular readmissions, or hemorrhagic strokes, though they did experience minor yet substantial gastrointestinal bleeding increases. The authors concluded that DOAC use at discharge was correlated with better long-term results vs warfarin in patients with acute ischemic stroke and AF.

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