Could NOACs Be Better Option Than Warfarin To Prevent Ischemic Stroke? Interview with:

Taku Inohara MD Department of Cardiology, Keio University School of Medicine Tokyo, Japan Duke Clinical Research Institute, Duke University Medical Center Durham, NC 

Dr. Taku Inohara

Taku Inohara MD
Department of Cardiology, Keio University School of Medicine
Tokyo, Japan
Duke Clinical Research Institute, Duke University Medical Center
Durham, NC What is the background for this study? What are the main findings? 

Response: Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly prescribed for high-risk patients with atrial fibrillation because they have fewer bleeding complications than warfarin. However, they still pose a risk of intracerebral hemorrhage (ICH). It was unclear if patients with preceding use of NOACs who experienced an ICH were at greater risk of death than patients with no oral anticoagulant (OAC)  or patients who received warfarin.

Using the GWTG-Stroke registry, we found that, while prior use of both NOACs and warfarin was associated with a greater risk of in-hospital mortality than no OAC, patients with prior use of NOACs were more likely to have favorable outcomes than patients with prior use of warfarin. In addition, the lower mortality in NOACs compared with warfarin was more likely to be prominent in patients with dual antiplatelet agents than those without antiplatelet therapy. What should readers take away from your report?

Response: High risk patients with atrial fibrillation have to be taking anticoagulation anyway, even ICH occurs, NOACs could still be a better option than warfarin to prevent ischemic stroke.

Physicians should consider NOACs as a safer anticoagulant strategy than warfarin in terms of the severity of their most devastating complication, despite lack of antidotes for current NOACs. What recommendations do you have for future research as a result of this work?

Response: Our findings have the potential to inform future treatment selection when oral anticoagulation is warranted. Future study needs to clarify the temporal trend of OAC-related ICH in parallel of the implementation of NOACs and focus on how the widespread use of NOACs affect the outcome of patients experiencing OAC-related ICH. Is there anything else you would like to add?

Response: The GWTG-Stroke program is provided by the American Heart Association/American Stroke Association (AHA/ASA). This study is in part supported by the ARAMIS registry with research funding from Daiichi Sankyo, Inc., Genentech, Inc., and Janssen. 


Inohara T, Xian Y, Liang L, Matsouaka RA, Saver JL, Smith EE, Schwamm LH, Reeves MJ, Hernandez AF, Bhatt DL, Peterson ED, Fonarow GC. Association of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality. JAMA. Published online January 25, 2018. doi:10.1001/jama.2017.21917

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Last Updated on January 26, 2018 by Marie Benz MD FAAD