Ann Neurol: Comparison of direct oral anticoagulants with vitamin K antagonists in patients with atrial fibrillation in ischemic stroke recently

In this study, we compared the treatment results of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in atrial fibrillation (AF) and recent cerebral ischemia patientsresearchers analyzed individual patient data on seven prospective cohort studiesPatients with atrial fibrillation and recent cerebral ischemia (3 months prior to the start of oral anticoagulant therapy) were followed up for a minimum of 3 monthsThe association between anticoagulant type (DOAC and VKA) and the combined primary endpoint (recurrent cerebral ischemic stroke (AIS), intrabrain hemorrhage (ICH) or mortality) was analyzed using the mixed effect Cox proportional hazard factor regression model;study included 4,912 patients (median age 78 years (IQR), 71-84 years), 2,331 women , 47.5 percent, the National Institutes of Health stroke severity scale at the time of onset of the disease was 5 (IQR, 2-12), 2,256 (45.9%) patients received KAKA, 2,656 (54.1 DO) accepted ACThe median time between the exponential event and the start of oral anticoagulant is 5 days (IQR, 2-14) and the DOACs are 5 days (IQR, 2-11) (P - 0.53)Of the total follow-up of 5970 patients, 262 were acute ischemic stroke (AISs; 4.4%/year), 71 cases of intracranial hemorrhage (ICHs; 1.2%/year) and 439 deaths (7.4%/year)Compared to VKA, DOAC treatment and integrated endpoint (HR, 0.82; 95% CI, 0.67-1.00; p - 0.05) and ICH (HR, 0.42; 95% CI, 0.24-071; p 0.01); We found no difference between the risk of recurrent AIS (HR, 0.91; 95% CI, 0.70-1.19; p s 0.5) and mortality (HR, 0.83; 95% CI, 0.68-1.03; p s 0.09)in general, doAC therapy began early after recent cerebral ischemia-related atrial fibrillation compared to VKA, and compared to VKA, DOAC therapy was associated with a reduced risk of adverse clinical prognosis, mainly due to a reduced risk of myocardial ischemia