دورية أكاديمية
Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation.
| العنوان: | Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. |
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| المؤلفون: | Seiffge, David J., Paciaroni, Maurizio, Wilson, Duncan, Koga, Masatoshi, Macha, Kosmas, Cappellari, Manuel, Schaedelin, Sabine, Shakeshaft, Clare, Takagi, Masahito, Tsivgoulis, Georgios, Bonetti, Bruno, Kallmünzer, Bernd, Arihiro, Shoji, Alberti, Andrea, Polymeris, Alexandros A, Ambler, Gareth, Yoshimura, Sohei, Venti, Michele, Bonati, Leo H, Muir, Keith W, Yamagami, Hiroshi, Thilemann, Sebastian, Altavilla, Riccardo, Peters, Nils, Inoue, Manabu, Bobinger, Tobias, Agnelli, Giancarlo, Brown, Martin M, Sato, Shoichiro, Acciarresi, Monica, Jager, Hans Rolf, Bovi, Paolo, Schwab, Stefan, Lyrer, Philippe, Caso, Valeria, Toyoda, Kazunori, Werring, David J, Engelter, Stefan T, De Marchis, Gian Marco |
| المصدر: | Seiffge, David J.; Paciaroni, Maurizio; Wilson, Duncan; Koga, Masatoshi; Macha, Kosmas; Cappellari, Manuel; Schaedelin, Sabine; Shakeshaft, Clare; Takagi, Masahito; Tsivgoulis, Georgios; Bonetti, Bruno; Kallmünzer, Bernd; Arihiro, Shoji; Alberti, Andrea; Polymeris, Alexandros A; Ambler, Gareth; Yoshimura, Sohei; Venti, Michele; Bonati, Leo H; Muir, Keith W; . (2019). Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. Annals of neurology, 85(6), pp. 823-834. Wiley-Blackwell 10.1002/ana.25489 |
| بيانات النشر: | Wiley-Blackwell |
| سنة النشر: | 2019 |
| المجموعة: | BORIS (Bern Open Repository and Information System, University of Bern) |
| مصطلحات موضوعية: | 610 Medicine & health |
| الوصف: | OBJECTIVE We compared outcomes after treatment with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and a recent cerebral ischemia. METHODS We conducted an individual patient data analysis of seven prospective cohort studies. We included patients with AF and a recent cerebral ischemia (<3 months before starting oral anticoagulation) and a minimum follow-up of 3 months. We analyzed the association between type of anticoagulation (DOAC versus VKA) with the composite primary endpoint (recurrent ischemic stroke [AIS], intracerebral hemorrhage [ICH], or mortality) using mixed-effects Cox proportional hazards regression models; we calculated adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). RESULTS We included 4,912 patients (median age, 78 years [interquartile range {IQR}, 71-84]; 2,331 [47.5%] women; median National Institute of Health Stroke Severity Scale at onset, 5 [IQR, 2-12]); 2,256 (45.9%) patients received VKAs and 2,656 (54.1%) DOACs. Median time from index event to starting oral anticoagulation was 5 days (IQR, 2-14) for VKAs and 5 days (IQR, 2-11) for DOACs (p = 0.53). There were 262 acute ischemic strokes (AISs; 4.4%/year), 71 intracranial hemorrrhages (ICHs; 1.2%/year), and 439 deaths (7.4%/year) during the total follow-up of 5,970 patient-years. Compared to VKAs, DOAC treatment was associated with reduced risks of the composite endpoint (HR, 0.82; 95% CI, 0.67-1.00; p = 0.05) and ICH (HR, 0.42; 95% CI, 0.24-0.71; p < 0.01); we found no differences for the risk of recurrent AIS (HR, 0.91; 95% CI, 0.70-1.19; p = 0.5) and mortality (HR, 0.83; 95% CI, 0.68-1.03; p = 0.09). INTERPRETATION DOAC treatment commenced early after recent cerebral ischemia related to AF was associated with reduced risk of poor clinical outcomes compared to VKA, mainly attributed to lower risks of ICH. ANN NEUROL 2019;85:823-834. |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | English |
| العلاقة: | https://boris.unibe.ch/134794Test/ |
| الإتاحة: | https://doi.org/10.1002/ana.25489Test https://boris.unibe.ch/134794/7/Seiffge_et_al-2019-Annals_of_Neurology.pdfTest https://boris.unibe.ch/134794Test/ |
| حقوق: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.F6F416EE |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |