Effect of non‐vitamin‐K oral anticoagulants on stroke severity compared to warfarin: a meta‐analysis of randomized controlled trials
Background and purpose In addition to lowering stroke risk, warfarin use is also associated with reduced stroke severity in patients with atrial fibrillation and acute ischaemic stroke. It was sought to determine whether the effect of non‐vitamin‐K oral anticoagulants (NOACs), compared to warfarin,...
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| Veröffentlicht in: | European journal of neurology 2020-03, Vol.27 (3), p.413-418 |
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| container_title | European journal of neurology |
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| creator | Costello, M. Murphy, R. Judge, C. Ruttledge, S. Gorey, S. Loughlin, E. Hughes, D. Nolan, A. O’Donnell, M. J. Canavan, M. |
| description | Background and purpose
In addition to lowering stroke risk, warfarin use is also associated with reduced stroke severity in patients with atrial fibrillation and acute ischaemic stroke. It was sought to determine whether the effect of non‐vitamin‐K oral anticoagulants (NOACs), compared to warfarin, differed by stroke severity.
Methods
Phase III randomized controlled trials with participants who were randomized to receive NOACs or warfarin for stroke prevention in the setting of non‐valvular atrial fibrillation were identified. Stroke was classified into two categories, fatal or disabling stroke and non‐disabling stroke, and meta‐analyses were completed for both outcomes and for comparative case fatality of stroke amongst trials.
Results
Five randomized controlled trials met our inclusion criteria. In clinical trials evaluating the NOACs usually prescribed in clinical practice (four trials), acute stroke was reported in 1403 (1.86%) participants, 787 (1.04%) in the NOAC group [386 (0.51%) fatal or disabling, 401 (0.53%) non‐disabling] and 616 (0.82%) in the warfarin group [367 (0.49%) fatal or disabling, 249 (0.33%) non‐disabling]. On meta‐analysis NOACs were significantly superior to warfarin for fatal or disabling stroke (odds ratio [OR] 0.77; 95% confidence interval [CI] 0.66–0.89, I2 = 21%) and non‐disabling stroke (OR 0.85; 95% CI 0.73–0.98, I2 = 2%). The case fatality of stroke was no different between groups (OR 0.90, 95% CI 0.75–1.13, I2 = 0%), but the point estimate favoured NOACs.
Conclusion
In phase III trials of NOACs, for prevention of stroke in atrial fibrillation, NOACs are associated with a lower risk of both fatal/disabling and non‐disabling stroke compared to warfarin. |
| doi_str_mv | 10.1111/ene.14134 |
| format | Article |
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In addition to lowering stroke risk, warfarin use is also associated with reduced stroke severity in patients with atrial fibrillation and acute ischaemic stroke. It was sought to determine whether the effect of non‐vitamin‐K oral anticoagulants (NOACs), compared to warfarin, differed by stroke severity.
Methods
Phase III randomized controlled trials with participants who were randomized to receive NOACs or warfarin for stroke prevention in the setting of non‐valvular atrial fibrillation were identified. Stroke was classified into two categories, fatal or disabling stroke and non‐disabling stroke, and meta‐analyses were completed for both outcomes and for comparative case fatality of stroke amongst trials.
Results
Five randomized controlled trials met our inclusion criteria. In clinical trials evaluating the NOACs usually prescribed in clinical practice (four trials), acute stroke was reported in 1403 (1.86%) participants, 787 (1.04%) in the NOAC group [386 (0.51%) fatal or disabling, 401 (0.53%) non‐disabling] and 616 (0.82%) in the warfarin group [367 (0.49%) fatal or disabling, 249 (0.33%) non‐disabling]. On meta‐analysis NOACs were significantly superior to warfarin for fatal or disabling stroke (odds ratio [OR] 0.77; 95% confidence interval [CI] 0.66–0.89, I2 = 21%) and non‐disabling stroke (OR 0.85; 95% CI 0.73–0.98, I2 = 2%). The case fatality of stroke was no different between groups (OR 0.90, 95% CI 0.75–1.13, I2 = 0%), but the point estimate favoured NOACs.
Conclusion
In phase III trials of NOACs, for prevention of stroke in atrial fibrillation, NOACs are associated with a lower risk of both fatal/disabling and non‐disabling stroke compared to warfarin.</description><identifier>ISSN: 1351-5101</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.14134</identifier><identifier>PMID: 31774244</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Administration, Oral ; Anticoagulants ; Anticoagulants - therapeutic use ; Atrial Fibrillation - complications ; Brain Ischemia - diagnosis ; Brain Ischemia - etiology ; Brain Ischemia - prevention & control ; Cardiac arrhythmia ; Clinical trials ; Confidence intervals ; Fatalities ; Fibrillation ; Health risks ; Humans ; Meta-analysis ; non‐vitamin‐K antagonists ; Prevention ; primary prevention ; quality and outcomes ; Randomization ; Randomized Controlled Trials as Topic ; secondary prevention ; Severity of Illness Index ; Stroke ; Stroke - diagnosis ; Stroke - etiology ; Stroke - prevention & control ; stroke severity ; Warfarin ; Warfarin - therapeutic use</subject><ispartof>European journal of neurology, 2020-03, Vol.27 (3), p.413-418</ispartof><rights>2019 European Academy of Neurology</rights><rights>2019 European Academy of Neurology.</rights><rights>Copyright © 2020 European Academy of Neurology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4194-152ade3c2883b1c7171b7c151bf2176e536e649a881cd228fbc2efe0d69039cc3</citedby><cites>FETCH-LOGICAL-c4194-152ade3c2883b1c7171b7c151bf2176e536e649a881cd228fbc2efe0d69039cc3</cites><orcidid>0000-0001-5446-4175 ; 0000-0002-8305-6610</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.14134$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.14134$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31774244$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Costello, M.</creatorcontrib><creatorcontrib>Murphy, R.</creatorcontrib><creatorcontrib>Judge, C.</creatorcontrib><creatorcontrib>Ruttledge, S.</creatorcontrib><creatorcontrib>Gorey, S.</creatorcontrib><creatorcontrib>Loughlin, E.</creatorcontrib><creatorcontrib>Hughes, D.</creatorcontrib><creatorcontrib>Nolan, A.</creatorcontrib><creatorcontrib>O’Donnell, M. J.</creatorcontrib><creatorcontrib>Canavan, M.</creatorcontrib><title>Effect of non‐vitamin‐K oral anticoagulants on stroke severity compared to warfarin: a meta‐analysis of randomized controlled trials</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background and purpose
In addition to lowering stroke risk, warfarin use is also associated with reduced stroke severity in patients with atrial fibrillation and acute ischaemic stroke. It was sought to determine whether the effect of non‐vitamin‐K oral anticoagulants (NOACs), compared to warfarin, differed by stroke severity.
Methods
Phase III randomized controlled trials with participants who were randomized to receive NOACs or warfarin for stroke prevention in the setting of non‐valvular atrial fibrillation were identified. Stroke was classified into two categories, fatal or disabling stroke and non‐disabling stroke, and meta‐analyses were completed for both outcomes and for comparative case fatality of stroke amongst trials.
Results
Five randomized controlled trials met our inclusion criteria. In clinical trials evaluating the NOACs usually prescribed in clinical practice (four trials), acute stroke was reported in 1403 (1.86%) participants, 787 (1.04%) in the NOAC group [386 (0.51%) fatal or disabling, 401 (0.53%) non‐disabling] and 616 (0.82%) in the warfarin group [367 (0.49%) fatal or disabling, 249 (0.33%) non‐disabling]. On meta‐analysis NOACs were significantly superior to warfarin for fatal or disabling stroke (odds ratio [OR] 0.77; 95% confidence interval [CI] 0.66–0.89, I2 = 21%) and non‐disabling stroke (OR 0.85; 95% CI 0.73–0.98, I2 = 2%). The case fatality of stroke was no different between groups (OR 0.90, 95% CI 0.75–1.13, I2 = 0%), but the point estimate favoured NOACs.
Conclusion
In phase III trials of NOACs, for prevention of stroke in atrial fibrillation, NOACs are associated with a lower risk of both fatal/disabling and non‐disabling stroke compared to warfarin.</description><subject>Administration, Oral</subject><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - complications</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - etiology</subject><subject>Brain Ischemia - prevention & control</subject><subject>Cardiac arrhythmia</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Fatalities</subject><subject>Fibrillation</subject><subject>Health risks</subject><subject>Humans</subject><subject>Meta-analysis</subject><subject>non‐vitamin‐K antagonists</subject><subject>Prevention</subject><subject>primary prevention</subject><subject>quality and outcomes</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic</subject><subject>secondary prevention</subject><subject>Severity of Illness Index</subject><subject>Stroke</subject><subject>Stroke - diagnosis</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>stroke severity</subject><subject>Warfarin</subject><subject>Warfarin - therapeutic use</subject><issn>1351-5101</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kb1OHDEURq0IFGCTIi8QWaIhxYCv7flLh9AGEChpknrk8VxHJjP2xp5ZtFSpqXhGngRPllBEws39inOPdfUR8gHYMaR3gg6PQYKQb8g-yKLKQAjYSVnkkOXAYI8cxHjDGOMlZ2_JnoCylFzKfXK_NAb1SL2hzrvHPw9rO6rBzumK-qB6qtxotVc_pz6lSL2jcQz-F9KIawx23FDth5UK2NHR01sVjArWfaaKDjiq5FFO9Zto4_xHUK7zg71LsPYuefp-3gtW9fEd2TVp4PvnuSA_viy_n11k19_OL89OrzMtoZYZ5Fx1KDSvKtGCLqGEttSQQ2s4lAXmosBC1qqqQHecV6bVHA2yrqiZqLUWC3K09a6C_z1hHJvBRo19ug_9FBsuoIa6hORfkMP_0Bs_hXTPTOU8B1nldaI-bSkdfIwBTbMKdlBh0wBr5oKaVFDzt6DEfnw2Tu2A3Qv5r5EEnGyBW9vj5nVTs_y63CqfACDLnng</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Costello, M.</creator><creator>Murphy, R.</creator><creator>Judge, C.</creator><creator>Ruttledge, S.</creator><creator>Gorey, S.</creator><creator>Loughlin, E.</creator><creator>Hughes, D.</creator><creator>Nolan, A.</creator><creator>O’Donnell, M. J.</creator><creator>Canavan, M.</creator><general>John Wiley & Sons, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5446-4175</orcidid><orcidid>https://orcid.org/0000-0002-8305-6610</orcidid></search><sort><creationdate>202003</creationdate><title>Effect of non‐vitamin‐K oral anticoagulants on stroke severity compared to warfarin: a meta‐analysis of randomized controlled trials</title><author>Costello, M. ; Murphy, R. ; Judge, C. ; Ruttledge, S. ; Gorey, S. ; Loughlin, E. ; Hughes, D. ; Nolan, A. ; O’Donnell, M. J. ; Canavan, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4194-152ade3c2883b1c7171b7c151bf2176e536e649a881cd228fbc2efe0d69039cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Administration, Oral</topic><topic>Anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>Atrial Fibrillation - complications</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - etiology</topic><topic>Brain Ischemia - prevention & control</topic><topic>Cardiac arrhythmia</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Fatalities</topic><topic>Fibrillation</topic><topic>Health risks</topic><topic>Humans</topic><topic>Meta-analysis</topic><topic>non‐vitamin‐K antagonists</topic><topic>Prevention</topic><topic>primary prevention</topic><topic>quality and outcomes</topic><topic>Randomization</topic><topic>Randomized Controlled Trials as Topic</topic><topic>secondary prevention</topic><topic>Severity of Illness Index</topic><topic>Stroke</topic><topic>Stroke - diagnosis</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>stroke severity</topic><topic>Warfarin</topic><topic>Warfarin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Costello, M.</creatorcontrib><creatorcontrib>Murphy, R.</creatorcontrib><creatorcontrib>Judge, C.</creatorcontrib><creatorcontrib>Ruttledge, S.</creatorcontrib><creatorcontrib>Gorey, S.</creatorcontrib><creatorcontrib>Loughlin, E.</creatorcontrib><creatorcontrib>Hughes, D.</creatorcontrib><creatorcontrib>Nolan, A.</creatorcontrib><creatorcontrib>O’Donnell, M. J.</creatorcontrib><creatorcontrib>Canavan, M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Costello, M.</au><au>Murphy, R.</au><au>Judge, C.</au><au>Ruttledge, S.</au><au>Gorey, S.</au><au>Loughlin, E.</au><au>Hughes, D.</au><au>Nolan, A.</au><au>O’Donnell, M. J.</au><au>Canavan, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of non‐vitamin‐K oral anticoagulants on stroke severity compared to warfarin: a meta‐analysis of randomized controlled trials</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2020-03</date><risdate>2020</risdate><volume>27</volume><issue>3</issue><spage>413</spage><epage>418</epage><pages>413-418</pages><issn>1351-5101</issn><eissn>1468-1331</eissn><abstract>Background and purpose
In addition to lowering stroke risk, warfarin use is also associated with reduced stroke severity in patients with atrial fibrillation and acute ischaemic stroke. It was sought to determine whether the effect of non‐vitamin‐K oral anticoagulants (NOACs), compared to warfarin, differed by stroke severity.
Methods
Phase III randomized controlled trials with participants who were randomized to receive NOACs or warfarin for stroke prevention in the setting of non‐valvular atrial fibrillation were identified. Stroke was classified into two categories, fatal or disabling stroke and non‐disabling stroke, and meta‐analyses were completed for both outcomes and for comparative case fatality of stroke amongst trials.
Results
Five randomized controlled trials met our inclusion criteria. In clinical trials evaluating the NOACs usually prescribed in clinical practice (four trials), acute stroke was reported in 1403 (1.86%) participants, 787 (1.04%) in the NOAC group [386 (0.51%) fatal or disabling, 401 (0.53%) non‐disabling] and 616 (0.82%) in the warfarin group [367 (0.49%) fatal or disabling, 249 (0.33%) non‐disabling]. On meta‐analysis NOACs were significantly superior to warfarin for fatal or disabling stroke (odds ratio [OR] 0.77; 95% confidence interval [CI] 0.66–0.89, I2 = 21%) and non‐disabling stroke (OR 0.85; 95% CI 0.73–0.98, I2 = 2%). The case fatality of stroke was no different between groups (OR 0.90, 95% CI 0.75–1.13, I2 = 0%), but the point estimate favoured NOACs.
Conclusion
In phase III trials of NOACs, for prevention of stroke in atrial fibrillation, NOACs are associated with a lower risk of both fatal/disabling and non‐disabling stroke compared to warfarin.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>31774244</pmid><doi>10.1111/ene.14134</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-5446-4175</orcidid><orcidid>https://orcid.org/0000-0002-8305-6610</orcidid></addata></record> |
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| ispartof | European journal of neurology, 2020-03, Vol.27 (3), p.413-418 |
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| source | MEDLINE; Wiley Online Library Journals |
| subjects | Administration, Oral Anticoagulants Anticoagulants - therapeutic use Atrial Fibrillation - complications Brain Ischemia - diagnosis Brain Ischemia - etiology Brain Ischemia - prevention & control Cardiac arrhythmia Clinical trials Confidence intervals Fatalities Fibrillation Health risks Humans Meta-analysis non‐vitamin‐K antagonists Prevention primary prevention quality and outcomes Randomization Randomized Controlled Trials as Topic secondary prevention Severity of Illness Index Stroke Stroke - diagnosis Stroke - etiology Stroke - prevention & control stroke severity Warfarin Warfarin - therapeutic use |
| title | Effect of non‐vitamin‐K oral anticoagulants on stroke severity compared to warfarin: a meta‐analysis of randomized controlled trials |
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