PMID- 30869568
OWN - NLM
STAT- In-Data-Review
LR  - 20190416
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 50
IP  - 4
DP  - 2019 Apr
TI  - Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Atrial
      Fibrillation Patients With Intracerebral Hemorrhage.
PG  - 939-946
LID - 10.1161/STROKEAHA.118.023797 [doi]
AB  - Background and Purpose- Recurrent bleeding associated with oral anticoagulants
      (OACs) causes a dilemma in patients with atrial fibrillation (AF) sustaining an
      intracerebral hemorrhage. Treatment recommendations guiding clinical practice on 
      optimal OAC agent selection in this population are lacking. This study aimed to
      investigate the comparative effectiveness and safety of non-vitamin K antagonist 
      OAC (NOAC) versus warfarin in patients with AF sustaining an intracerebral
      hemorrhage. Methods- We conducted a nationwide observational cohort study
      including patients with AF sustaining an intracerebral hemorrhage and who
      subsequently claimed an OAC prescription. Contrasts of 1-year risks for ischemic 
      stroke and intracerebral hemorrhage risks were obtained and evaluated by inverse 
      probability treatment weighted absolute risk reduction and risk ratios. Results- 
      Among 622 AF patients with intracerebral hemorrhage, 274 claimed a warfarin
      prescription and 348 a NOAC prescription. Mean age was 76 years (39% females);
      72% had an index nonsevere event and 28% moderate to severe index event according
      to the Scandinavian Stroke Severity scale. The 1-year ischemic stroke risk was
      7.85% for warfarin and 4.01% for NOACs, with a weighted absolute risk reduction
      of 3.78% (95% CI, -0.15% to 7.71%); the weighted risk ratio was 0.52 (0.27-1.00).
      For recurrent intracerebral hemorrhage, the risk was 7.00% for warfarin and 5.07%
      for NOACs. The absolute risk reduction was 1.93% (-2.02% to 5.87%), with an a
      weighted risk ratio of 0.72 (0.38-1.38). Conclusions- NOACs were associated with 
      a nonsignificant lower risk of ischemic stroke and recurrent intracerebral
      hemorrhage compared with warfarin. The results add to current recommendations of 
      selecting a NOAC agent for stroke prophylaxis treatment in patients with AF,
      including those with sustaining an intracerebral hemorrhage.
FAU - Nielsen, Peter Bronnum
AU  - Nielsen PB
AD  - From the Department of Cardiology (P.B.N., M.S., J.N.K., T.B.L.), Aalborg
      University Hospital, Denmark.
AD  - Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of
      Health, Aalborg University, Denmark (P.B.N., F.S., M.S., J.N.K., G.Y.H.L.,
      T.B.L.).
FAU - Skjoth, Flemming
AU  - Skjoth F
AD  - Unit of Clinical Biostatistics (F.S.), Aalborg University Hospital, Denmark.
AD  - Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of
      Health, Aalborg University, Denmark (P.B.N., F.S., M.S., J.N.K., G.Y.H.L.,
      T.B.L.).
FAU - Sogaard, Mette
AU  - Sogaard M
AD  - From the Department of Cardiology (P.B.N., M.S., J.N.K., T.B.L.), Aalborg
      University Hospital, Denmark.
AD  - Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of
      Health, Aalborg University, Denmark (P.B.N., F.S., M.S., J.N.K., G.Y.H.L.,
      T.B.L.).
FAU - Kjaeldgaard, Jette Nordstrom
AU  - Kjaeldgaard JN
AD  - From the Department of Cardiology (P.B.N., M.S., J.N.K., T.B.L.), Aalborg
      University Hospital, Denmark.
AD  - Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of
      Health, Aalborg University, Denmark (P.B.N., F.S., M.S., J.N.K., G.Y.H.L.,
      T.B.L.).
FAU - Lip, Gregory Y H
AU  - Lip GYH
AD  - Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of
      Health, Aalborg University, Denmark (P.B.N., F.S., M.S., J.N.K., G.Y.H.L.,
      T.B.L.).
AD  - Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
      (G.Y.H.L.).
FAU - Larsen, Torben Bjerregaard
AU  - Larsen TB
AD  - From the Department of Cardiology (P.B.N., M.S., J.N.K., T.B.L.), Aalborg
      University Hospital, Denmark.
AD  - Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of
      Health, Aalborg University, Denmark (P.B.N., F.S., M.S., J.N.K., G.Y.H.L.,
      T.B.L.).
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
PMC - PMC6430592
OTO - NOTNLM
OT  - anticoagulants
OT  - atrial fibrillation
OT  - brain infarction
OT  - cerebral hemorrhage
EDAT- 2019/03/15 06:00
MHDA- 2019/03/15 06:00
CRDT- 2019/03/15 06:00
PHST- 2019/03/15 06:00 [pubmed]
PHST- 2019/03/15 06:00 [medline]
PHST- 2019/03/15 06:00 [entrez]
AID - 10.1161/STROKEAHA.118.023797 [doi]
PST - ppublish
SO  - Stroke. 2019 Apr;50(4):939-946. doi: 10.1161/STROKEAHA.118.023797.