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Safety and efficacy of non-vitamin K oral anticoagulant treatment compared with warfarin in patients with non-valvular atrial fibrillation who develop acute ischemic stroke or transient ischemic attack: a multicenter prospective cohort study (daVinci study)

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Abstract

The safety and efficacy of non-vitamin K oral anticoagulant (NOAC) compared with warfarin in treating patients with non-valvular atrial fibrillation (NVAF) who developed acute ischemic stroke or transient ischemic attack (AIS/TIA), particularly those receiving tissue-plasminogen activator (tPA) therapy, remains unclear. Between April 2012 and December 2014, we conducted a multicenter prospective cohort study to assess the current clinical practice for treating such patients. We divided the patients into two groups according to the administration of oral anticoagulants (warfarin or NOACs) and tPA therapy. The risk of any hemorrhagic or ischemic event was compared within 1 month after the onset of stroke. We analyzed 235 patients with AIS/TIA including 73 who received tPA therapy. Oral anticoagulants were initiated within 2–4 inpatient days. NOACs were administered to 49.8 % of patients, who were predominantly male, younger, had small infarcts, lower NIHSS scores, and had a lower all-cause mortality rate (0 vs. 4.2 %, P = 0.06) and a lower risk of any ischemic events (6.0 vs. 7.6 %, P = 0.797) compared with warfarin users. The prevalence of all hemorrhagic events was equivalent between the two groups. Early initiation of NOACs after tPA therapy appeared to lower the risk of hemorrhagic events, although there was no significant difference (0 vs. 5.6 %, P = 0.240). Although more clinicians are apt to prescribe NOACs in minor ischemic stroke, NOAC treatment may provide a potential benefit in such cases. Early initiation of NOACs after tPA therapy may reduce the risk of hemorrhagic events compared with warfarin.

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Acknowledgments

We are grateful to Takashi Sakurai, Kazumasa Yamada (Center for Comprehensive Care and Research on Memory Disorders, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology), and Kenta Murotani (Center for Clinical Research, Aichi Medical University) for their technical support.

Sources of Funding

This study was supported by an intramural research fund for Department of Stroke Medicine, Kawasaki Medical School.

Disclosure

Dr. Saji discloses the following research grants: Research Funding of Longevity Sciences (25-6, 28-15) from the National Center for Geriatrics and Gerontology (NCGG), Grants-in-Aid for Scientific Research (No. 26870765), from the Japan Society for the Promotion of Science, Japan Foundation for Aging and Health, and Comprehensive Research on Aging and Health from the Japan Agency for Medical Research and Development, AMED.

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Authors and Affiliations

  1. Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan

    Naoki Saji

  2. Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan

    Naoki Saji

  3. Department of Neurological Science, Nippon Medical School Graduate School of Medicine, Bunkyo, Tokyo, Japan

    Kazumi Kimura

  4. Cerebrovascular Center, Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Nagasaki, Japan

    Yohei Tateishi & Akira Tsujino

  5. Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Fukuoka, Japan

    Shigeru Fujimoto

  6. Stroke Center, Okinawa Kyodo Hospital, Naha, Okinawa, Japan

    Nobuyuki Kaneko

  7. Department of Neurology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan

    Takao Urabe

  8. Department of Neurology, The Jikei University School of Medicine, Minato, Tokyo, Japan

    Yasuyuki Iguchi

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  1. Naoki Saji
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  2. Kazumi Kimura
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daVinci Study Group

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Correspondence to Naoki Saji.

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Saji, N., Kimura, K., Tateishi, Y. et al. Safety and efficacy of non-vitamin K oral anticoagulant treatment compared with warfarin in patients with non-valvular atrial fibrillation who develop acute ischemic stroke or transient ischemic attack: a multicenter prospective cohort study (daVinci study). J Thromb Thrombolysis 42, 453–462 (2016). https://doi.org/10.1007/s11239-016-1376-x

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