Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment
Background The optimal antithrombotic strategies for patients with atrial fibrillation who experience ischemic stroke (IS) despite direct oral anticoagulant (DOAC) therapy remain inconclusive. This study compared outcomes for patients with DOAC treatment failure who changed or retained their prestro...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.032454 |
| _version_ | 1797296265568976896 |
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| author | Shin‐Yi Lin Yun‐Tsz Liao Sung‐Chun Tang Ching‐Ching Claire Lin Chi‐Chuan Wang |
| author_facet | Shin‐Yi Lin Yun‐Tsz Liao Sung‐Chun Tang Ching‐Ching Claire Lin Chi‐Chuan Wang |
| author_sort | Shin‐Yi Lin |
| collection | DOAJ |
| description | Background The optimal antithrombotic strategies for patients with atrial fibrillation who experience ischemic stroke (IS) despite direct oral anticoagulant (DOAC) therapy remain inconclusive. This study compared outcomes for patients with DOAC treatment failure who changed or retained their prestroke DOAC. Methods and Results This retrospective cohort study analyzed data from the National Health Insurance Research Database from 2012 to 2020. Patients with atrial fibrillation who experienced IS during DOAC therapy were assigned to either (1) the DOAC‐change group: changing prestroke DOAC or (2) the DOAC‐retain group: retaining prestroke DOAC. The primary outcome was a composite of recurrent IS and transient ischemic attack. The secondary outcomes included intracranial hemorrhage, major bleeding, systemic thromboembolism, and all‐cause death. Propensity score–based inverse probability of treatment weighting was applied to balance the baseline characteristics between the DOAC‐change and DOAC‐retain groups. The Cox proportional hazards model compared the risk of outcomes between the 2 groups. In total, 1979 patients were enrolled (609 DOAC‐change patients and 1370 DOAC‐retain patients). The incidence rates of recurrent IS or transient ischemic attack were 7.20 and 6.56 per 100 person‐years in the DOAC‐change and DOAC‐retain groups, respectively (hazard ratio [HR], 1.07 [95% CI, 0.87–1.30]). A nonsignificantly higher incidence rate of intracranial hemorrhage was observed in the DOAC‐change group compared with the DOAC‐retain group (0.75 versus 0.53 per 100‐person‐years; HR, 1.49 [95% CI, 0.78–2.83]). The systemic thromboembolism, major bleeding, and death rates were comparable between the DOAC‐change and DOAC‐retain groups. Conclusions Changing prestroke DOAC does not reduce the risk of recurrent cerebral ischemia in patients with atrial fibrillation who develop IS during DOAC therapy. However, future studies should continue to observe the potential trends of increased intracranial hemorrhage risk. |
| first_indexed | 2024-03-07T22:02:06Z |
| format | Article |
| id | doaj.art-486f093d59dc43fe978b6b51c76a65e1 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:02:06Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-486f093d59dc43fe978b6b51c76a65e12024-02-24T04:06:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-02-0113310.1161/JAHA.123.032454Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant TreatmentShin‐Yi Lin0Yun‐Tsz Liao1Sung‐Chun Tang2Ching‐Ching Claire Lin3Chi‐Chuan Wang4Department of Pharmacy National Taiwan University Hospital Taipei TaiwanDepartment of Pharmacy National Taiwan University Hospital Taipei TaiwanStroke Center and Department of Neurology National Taiwan University Hospital Taipei TaiwanInstitute of Health Policy and Management College of Public Health, National Taiwan University Taipei TaiwanDepartment of Pharmacy National Taiwan University Hospital Taipei TaiwanBackground The optimal antithrombotic strategies for patients with atrial fibrillation who experience ischemic stroke (IS) despite direct oral anticoagulant (DOAC) therapy remain inconclusive. This study compared outcomes for patients with DOAC treatment failure who changed or retained their prestroke DOAC. Methods and Results This retrospective cohort study analyzed data from the National Health Insurance Research Database from 2012 to 2020. Patients with atrial fibrillation who experienced IS during DOAC therapy were assigned to either (1) the DOAC‐change group: changing prestroke DOAC or (2) the DOAC‐retain group: retaining prestroke DOAC. The primary outcome was a composite of recurrent IS and transient ischemic attack. The secondary outcomes included intracranial hemorrhage, major bleeding, systemic thromboembolism, and all‐cause death. Propensity score–based inverse probability of treatment weighting was applied to balance the baseline characteristics between the DOAC‐change and DOAC‐retain groups. The Cox proportional hazards model compared the risk of outcomes between the 2 groups. In total, 1979 patients were enrolled (609 DOAC‐change patients and 1370 DOAC‐retain patients). The incidence rates of recurrent IS or transient ischemic attack were 7.20 and 6.56 per 100 person‐years in the DOAC‐change and DOAC‐retain groups, respectively (hazard ratio [HR], 1.07 [95% CI, 0.87–1.30]). A nonsignificantly higher incidence rate of intracranial hemorrhage was observed in the DOAC‐change group compared with the DOAC‐retain group (0.75 versus 0.53 per 100‐person‐years; HR, 1.49 [95% CI, 0.78–2.83]). The systemic thromboembolism, major bleeding, and death rates were comparable between the DOAC‐change and DOAC‐retain groups. Conclusions Changing prestroke DOAC does not reduce the risk of recurrent cerebral ischemia in patients with atrial fibrillation who develop IS during DOAC therapy. However, future studies should continue to observe the potential trends of increased intracranial hemorrhage risk.https://www.ahajournals.org/doi/10.1161/JAHA.123.032454atrial fibrillationchanging DOACdirect oral anticoagulantischemic stroke |
| spellingShingle | Shin‐Yi Lin Yun‐Tsz Liao Sung‐Chun Tang Ching‐Ching Claire Lin Chi‐Chuan Wang Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation changing DOAC direct oral anticoagulant ischemic stroke |
| title | Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment |
| title_full | Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment |
| title_fullStr | Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment |
| title_full_unstemmed | Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment |
| title_short | Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment |
| title_sort | changing or retaining direct oral anticoagulant after ischemic stroke despite direct oral anticoagulant treatment |
| topic | atrial fibrillation changing DOAC direct oral anticoagulant ischemic stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.032454 |
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