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Published on: February 28, 2012
Stroke Prevention by Anticoagulants in Daily Practice Depending on Atrial Fibrillation Pattern and Clinical Risk
Lamiae Grimaldi-Bensouda1,2, Jean-Yves Le Heuzey3, Jean Ferrières4
1The PGRx Study Group, Paris, France (L.G.-B.).
Insights
Direct oral anticoagulants (DOACs) show reduced stroke risk compared to vitamin K antagonists in real-world atrial fibrillation (AF) patient care. DOAC effectiveness for stroke prevention was consistent across different AF types.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Atrial fibrillation (AF) is a significant risk factor for stroke.
- Vitamin K antagonists (VKAs) have been standard anticoagulants, but direct oral anticoagulants (DOACs) offer an alternative.
- Real-world effectiveness of DOACs versus VKAs for primary stroke prevention in diverse AF patient populations requires assessment.
Purpose of the Study:
- To evaluate the comparative effectiveness of individual DOACs against VKAs.
- To assess primary stroke prevention (ischemic and hemorrhagic) in routine clinical practice.
- To analyze outcomes based on patient clinical risk factors and atrial fibrillation patterns.
Main Methods:
- A nested case-referent study utilized national stroke and AF patient registries.
- Stroke cases with prior AF were matched with referent patients with AF but no stroke.
- Multivariable conditional logistic models analyzed anticoagulant associations with stroke, controlling for clinical risk factors.
Main Results:
- DOAC users exhibited lower odds of any stroke compared to VKA users.
- Adjusted odds ratios for ischemic stroke: dabigatran (0.70), rivaroxaban (0.68), apixaban (0.73).
- Adjusted odds ratios for hemorrhagic stroke: dabigatran (0.31), rivaroxaban (0.64), apixaban (0.70).
Conclusions:
- Real-world findings for DOACs align with pivotal clinical trial results for stroke prevention.
- Individual DOACs demonstrated comparable or superior effectiveness to VKAs in preventing stroke.
- Atrial fibrillation pattern did not significantly influence the observed treatment outcomes.
Background And Purpose:
The objective of the study was to assess the effectiveness of individual direct oral anticoagulants versus vitamin K antagonists for primary prevention of stroke (ischemic and hemorrhagic) in routine clinical practice in patients with various clinical risk factors depending on their atrial fibrillation (AF) patterns.
Methods:
A nested case-referent study was conducted using data from 2 national registries of patients with stroke and AF. Stroke cases with previous history of AF were matched to up to 2 randomly selected referent patients with AF and no stroke. The association of individual anticoagulant use with ischemic or hemorrhagic stroke was studied in patients with or without permanent AF using multivariable conditional logistic models, controlled for clinically significant risk factors and multiple other cardiovascular risk factors.
Results:
In total, 2586 stroke cases with previous AF and 4810 nonstroke referent patients with AF were retained for the study. Direct oral anticoagulant users had lower odds of stroke of any type than vitamin K antagonist users: the adjusted-matched OR for ischemic stroke were 0.70 (95% CI, 0.50–0.98) for dabigatran, 0.68 (95% CI, 0.53–0.86) for rivaroxaban, and 0.73 (95% CI, 0.52–1.02) for apixaban while for hemorrhagic stroke they were 0.31 (95% CI, 0.14–0.68), 0.64 (95% CI, 0.39–1.06), and 0.70 (95% CI, 0.33–1.49), respectively. The effects of individual direct oral anticoagulants relative to vitamin K antagonists were similar in permanent AF and nonpermanent AF patients.
Conclusions:
Similar results were observed for each direct oral anticoagulant in real life as those observed in the pivotal clinical trials. The pattern of AF did not affect the outcome.
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