Oral Anticoagulants in Atrial Fibrillation Patients with Recent Stroke Who Are Dependent on the Daily Help of Others

Abstract

Background and Purpose: Data on the effectiveness and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with stroke attributable to atrial fibrillation (AF) who were dependent on the daily help of others at hospital discharge are scarce. Methods: Based on prospectively obtained data from the observational Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-longterm registry from Basel, Switzerland, we compared the occurrence of the primary outcome-the composite of recurrent ischemic stroke, major bleeding, and all-cause death-among consecutive patients with AF-stroke treated with either VKAs or DOACs between patients dependent (defined as modified Rankin Scale score, 3-5) and patients independent at discharge. We used simple, adjusted, and weighted Cox proportional hazards regression to account for potential confounders. Results: We analyzed 801 patients (median age 80 years, 46% female), of whom 391 (49%) were dependent at discharge and 680 (85%) received DOACs. Over a total follow-up of 1216 patient-years, DOAC-compared to VKA-Treated patients had a lower hazard for the composite outcome (hazard ratio [HR], 0.58 [95% CI, 0.42-0.81]), as did independent compared to dependent patients (HR, 0.54 [95% CI, 0.40-0.71]). There was no evidence that the effect of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome differed between dependent (HRdependent, 0.68 [95% CI, 0.45-1.01]) and independent patients (HRindependent, 0.44 [95% CI, 0.26-0.75]) in the simple model (Pinteraction=0.212). Adjusted (HRdependent, 0.74 [95% CI, 0.49-1.11] and HRindependent, 0.51 [95% CI, 0.30-0.87]; Pinteraction=0.284) and weighted models (HRdependent, 0.79 [95% CI, 0.48-1.31] and HRindependent, 0.46 [95% CI, 0.26-0.81]; Pinteraction=0.163) yielded concordant results. Secondary analyses focusing on the individual components of the composite outcome were consistent to the primary analyses. Conclusions: The benefits of DOACs in patients with atrial fibrillation with a recent stroke were maintained among patients who were dependent on the help of others at discharge. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03826927.