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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Prophylactic anticoagulation in sinus rhythm for stroke prevention in cardiovascular disease: contemporary

Krystle Lander1, Priyanka Thakeria1, Sachin Nayyar1

  • 1Department of Cardiology, Townsville University Hospital, James Cook University, 100, Angus Smith Drive, Townsville, QLD 4814, Australia.

European Journal of Preventive Cardiology
|July 5, 2021
PubMed

Insights

Non-vitamin K oral anticoagulants (NOACs) did not show a net clinical benefit for stroke prevention in patients with cardiovascular diseases but without atrial fibrillation. The increased risk of major bleeding outweighed the reduction in ischaemic strokes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Non-vitamin K oral anticoagulants (NOACs) are standard for stroke prevention in atrial fibrillation (AF).
  • Patients with cardiovascular diseases (CVDs) but without AF also face elevated ischaemic stroke risk.

Purpose of the Study:

  • To evaluate the efficacy and safety of prophylactic NOACs for stroke prevention in patients without AF.
  • To assess the net clinical benefit of NOACs in this specific patient population.

Main Methods:

  • Meta-analysis of randomized controlled trials (RCTs) comparing NOACs with placebo or antiplatelet agents.
  • Included non-AF patients with mixed CVD in sinus rhythm.
  • Primary outcomes: ischaemic stroke and major bleeding.

Main Results:

  • 13 RCTs involving 89,383 patients were analyzed.
  • NOACs reduced ischaemic stroke by 26% (OR 0.74) but significantly increased major bleeding (OR 1.74).
  • Weighted net clinical benefit analysis did not favor NOAC use at any dose.

Conclusions:

  • Current evidence does not support the prophylactic use of NOACs for stroke prevention in patients with CVD but without AF.
  • The heightened risk of major bleeding outweighs the observed benefit of reduced ischaemic stroke.
Abstract

Keywords:
Atrial fibrillationBleedingNon-vitamin K oral anticoagulant agentSinus rhythmStroke

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