Secondary prevention of cerebral infarct: Verification of appropriateness in choices of anticoagulant by comparison of current and previous treatment results

Abstract

We hypothesized that the treatment results for secondary prevention of cerebral infarct in patients with AF have improved as the therapeutic availability of anticoagulants has expanded, if the choice of drug and selection of dose were appropriate for the individual. To test this hypothesis, we analyzed a total of 425 patients who had been admitted due to stroke or TIA and had been prescribed anticoagulants on first discharge. Patients were divided into four groups according to the number of anticoagulants available in our hospital: warfarin alone as Period 1; warfarin and dabigatran as Period 2; warfarin, dabigatran, and rivaroxaban as Period 3; and warfarin, dabigatran, rivaroxaban, and apixaban as Period 4. We made it a principle to avoid unnecessary dose reduction as well as to choose the NOAC that did not meet the dose-reduction criteria for each individual patient in cases where we decided to treat patients with NOACs in Period 4 according to the treatment results in Periods 1-3. The incidences of recurrent stroke were 10.2 %, 12.0 %, 8.8 %, and 4.7 % in Periods 1, 2, 3, and 4, respectively. During the entire follow-up period, five cerebral infarcts occurred in patients treated with low-dose NOACs, with none in patients on standard-dose NOACs. In Period 4, no patient treated with NOACs experienced recurrent ischemic stroke. One small intracranial hemorrhage occurred in the patient treated with low-dose apixaban in Period 4. Comparisons of current and previous treatment results may be helpful to self-check the validity of the decision-making process in individual hospitals and can contribute to improved outcomes for secondary prevention of cerebral infarct.