Antithrombotic Strategies for Patients Experiencing Stroke While Taking Direct Oral Anticoagulants

Clinical Takeaway

: For patients with atrial fibrillation and a breakthrough stroke, maintaining treatment with a direct oral anticoagulant is better than switching to warfarin.

Context

Patients with atrial fibrillation (AF) who suffer an ischemic stroke while being treated with a direct oral anticoagulant (DOAC) are at high risk for future events. Still, data are limited on whether these patients should continue with DOAC treatment or switch to warfarin.

These researchers performed a meta-analysis of 8 observational studies with data on this question and a minimum of 50 patients. The meta-analysis included 14,300 patients, with a mean age of 75 years; 48% were women. The studies’ follow-up periods ranged from 3 to 21 months.

Key Results

Switching to warfarin was linked to a twofold higher risk for future stroke, compared with maintaining the current DOAC or changing its dose.
Switching to warfarin was associated with a…

Reviewing Author

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke