Two-Year Outcomes of Anticoagulation for Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation - SAMURAI-NVAF Study.
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Yoshimura Sohei, Koga Masatoshi, Sato Shoichiro, Todo Kenichi, Yamagami Hiroshi, Kumamoto Masaya, Itabashi Ryo, Terasaki Tadashi, Kimura Kazumi, Yagita Yoshiki, Shiokawa Yoshiaki, Kamiyama Kenji, Okuda Satoshi, Okada Yasushi, Takizawa Shunya, Hasegawa Yasuhiro, Kameda Tomoaki, Shibuya Satoshi, Nagakane Yoshinari, Ito Yasuhiro, Matsuoka Hideki, Takamatsu Kazuhiro, Nishiyama Kazutoshi, Fujita Kyohei, Kamimura Teppei, Ando Daisuke, Ide Toshihiro, Yoshimoto Takeshi, Shiozawa Masayuki, Matsubara Soichiro, Yamaguchi Yoshitaka, Kinoshita Naoto, Matsuki Takayuki, Takasugi Junji, Tokunaga Keisuke, Higashida Kyoko, Homma Kazunari, Kario Kazuomi, Arihiro Shoji, Toyoda Kazunori, SAMURAI Study Investigators
Аннотация
METHODS AND RESULTS: NVAF patients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS2and discharge modified Rankin Scale scores than warfarin users (P<0.0001 each). Incidences of stroke/systemic embolism (adjusted hazard ratio, 1.07; 95% CI, 0.66-1.72), all ischemic events (1.13; 0.72-1.75), and ischemic stroke/TIA (1.58; 0.95-2.62) were similar between groups. Risks of intracranial hemorrhage (0.32; 0.09-0.97) and death (0.41; 0.26-0.63) were significantly lower for DOAC users. Infection was the leading cause of death, accounting for 40% of deaths among warfarin users.
CONCLUSIONS: Stroke/TIA patients receiving DOACs for secondary prevention were younger and had lower stroke severity and risk indices than those receiving warfarin. Estimated cumulative incidences of stroke and systemic embolism within 2 years were similar between warfarin and DOACs users, but those of death and intracranial hemorrhage were significantly lower among DOAC users.