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Updated: Oct 29, 2025
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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
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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.).
Stroke
|July 13, 2021
Summary
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.
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