Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, South Korea.
Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.
Sci Rep. 2024 Apr 29;14(1):9838. doi: 10.1038/s41598-024-60660-z.
Previous studies have rarely investigated the role of non-vitamin K oral anticoagulants (NOAC) and warfarin in the secondary prevention of ischemic stroke patients with nonvalvular atrial fibrillation (NVAF). In this study, we compared the effectiveness and safety of NOAC and warfarin for secondary prevention in Korean ischemic stroke patients with NVAF. Based on the Korean National Health Insurance Service Database, this study included 21,064 oral anticoagulants-naïve acute ischemic stroke patients with NVAF between July 2015 and June 2019. The main study outcomes included ischemic stroke, systemic embolism, major bleeding, and death. During the observational periods, NOAC users had a significantly decreased risk of ischemic stroke + systemic embolism (adjusted hazard ratio [aHR] 0.86; 95% confidence interval [CI] 0.78-0.95), ischemic stroke (aHR 0.89; 95% CI 0.81-0.99), major bleeding (aHR 0.78; 95% CI 0.68-0.89), and all-cause death (aHR 0.87; 95% CI 0.81-0.93). Standard-dose NOAC users had a lower risk of ischemic stroke, systemic embolism, and major bleeding events than warfarin users. In contrast, low-dose NOAC users did not differ in risk from warfarin users for all outcomes. In conclusion, NOACs were associated with a lower risk of secondary thromboembolic events and bleeding complications in Korean ischemic stroke patients with NVAF than warfarin.
先前的研究很少探讨非维生素 K 口服抗凝剂 (NOAC) 和华法林在非瓣膜性心房颤动 (NVAF) 的缺血性脑卒中患者二级预防中的作用。在这项研究中,我们比较了 NOAC 和华法林在韩国 NVAF 缺血性脑卒中患者二级预防中的疗效和安全性。本研究基于韩国国家健康保险服务数据库,纳入了 2015 年 7 月至 2019 年 6 月间 21064 例口服抗凝剂初治的急性 NVAF 缺血性脑卒中患者。主要研究结局包括缺血性卒中和全身性栓塞、大出血和死亡。在观察期间,NOAC 使用者发生缺血性卒中和全身性栓塞(校正后的危险比[aHR] 0.86;95%置信区间[CI] 0.78-0.95)、缺血性卒中(aHR 0.89;95%CI 0.81-0.99)、大出血(aHR 0.78;95%CI 0.68-0.89)和全因死亡(aHR 0.87;95%CI 0.81-0.93)的风险显著降低。标准剂量的 NOAC 使用者发生缺血性卒中、全身性栓塞和大出血事件的风险低于华法林使用者。相比之下,低剂量的 NOAC 使用者与华法林使用者在所有结局方面的风险无差异。总之,与华法林相比,NOAC 可降低韩国 NVAF 缺血性脑卒中患者的继发性血栓栓塞事件和出血并发症风险。