Intracranial Hemorrhage Risk with NOACs vs Aspirin

MedicalResearch.com Interview with:
medical researchDr. Michael Lee
Department of Neurology
Chang Gung University College of Medicine
Chang Gung Memorial Hospital Taiwan

MedicalResearch.com: What is the background for this study?

Response: Although NOACs and aspirin are in general protective in different vascular beds, NOACs might be an attractive choice for stroke prevention in certain clinical situations, such as in people without recognized atrial fibrillation, but with an embolic stroke of undetermined source or atrial cardiopathy because of their propensity to also cause stroke through cardiac emboli.

Nonetheless, the benefit of NOACs over aspirin for stroke protection is likely to be less promising in people without atrial fibrillation, as compared to people with atrial fibrillation. Therefore it is even more important to clarify whether individual NOACs with of various doses harbor comparable risks of intracranial hemorrhage with aspirin based on the evidence currently available.

MedicalResearch.com: What are the main findings? 

Response: Rivaroxaban 15-20mg once daily substantially increased the risks of intracranial hemorrhage while rivaroxaban 10mg daily and apixaban 5mg twice daily were not. 

MedicalResearch.com: What should readers take away from your report?

Response: Rivaroxaban 15-20mg once daily possessed substantial higher risks of intracranial hemorrhage than aspirin, its use in people without atrial fibrillation could not be encouraged.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: It may be worthwhile to conduct randomized controlled trials comparing certain NOAC (e.g. apixaban 5mg twice daily) and aspirin in patients without atrial fibrillation, but with potential sources of cardiac emboli that can cause stroke.

No disclosures 

Citation:

Huang W, Singer DE, Wu Y, et al. Association of Intracranial Hemorrhage Risk With Non–Vitamin K Antagonist Oral Anticoagulant Use vs Aspirin UseA Systematic Review and Meta-AnalysisJAMA Neurol. Published online August 13, 2018. doi:10.1001/jamaneurol.2018.2215

 

Aug 15, 2018 @ 12:30 pm

 

 

 

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Real World Studies Compares Dabigatran with Rivaroxaban or Apixaban in Nonvalvular AFib

MedicalResearch.com Interview with:

Todd C. Villines, M.D. FSCCT Professor of Medicine Uniformed Services University School of Medicine Director of Cardiovascular Research and Cardiac CT Cardiology Fellowship Program Director Walter Reed National Military Medical Center Bethesda, Maryland Assistant Professor of Medicine Georgetown School of Medicine

Dr. Villines

Todd C. Villines, M.D. FSCCT
Professor of Medicine
Uniformed Services University School of Medicine
Director of Cardiovascular Research and Cardiac CT
Cardiology Fellowship Program Director
Walter Reed National Military Medical Center
Bethesda, Maryland
Assistant Professor of Medicine
Georgetown School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was a retrospective, observational real-world analysis assessing the safety and effectiveness of novel oral anticoagulants (NOACs) among patients with non-valvular atrial fibrillation (NVAF) treated through the U.S. Department of Defense Military Health System. The study examined major bleeding and stroke rates in NVAF patients who had initiated treatment with dabigatran compared to those treated with rivaroxaban or apixaban.

The study examined two cohorts: one that resulted in 12,763 propensity score matched dabigatran (150 mg bid) and rivaroxaban (20 mg daily) patients, and another that resulted in 4,802 propensity score matched dabigatran (150 mg bid) and apixaban (5 mg bid) patients. Dabigatran patients demonstrated lower rates of major bleeding compared to rivaroxaban patients (2.08 percent vs 2.53) percent and similar rates of stroke (0.60 percent vs 0.78 percent). In the exploratory analysis, dabigatran and apixaban patients showed similar rates of major bleeding (1.60 percent vs 1.21 percent) and stroke (0.44 percent vs 0.35 percent). Continue reading

Dementia Incidence Lower For Atrial Fibrillation Patients Treated With Anticoagulation

MedicalResearch.com Interview with:

Dr. Leif Friberg MD, PhD Associate professor in cardiology Karolinska Institute Friberg Resarch Stockholm, Sweden 

Dr. Leif Friberg

Dr. Leif Friberg MD, PhD
Associate professor in cardiology
Karolinska Institute
Friberg Resarch
Stockholm, Sweden 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I have been doing research on atrial fibrillation and stroke risk for many years and knew that the very common heart arrhythmia is associated with a 40% increased risk of dementia. Considering that that 12-15% of 75 years olds have this arrhythmia, and even more at higher ages, the problem is significant to say the least.

The mechanism behind stroke in atrial fibrillation is that blood clots are formed in the heart. When these are dislodged they travel with the blood stream and may get stuck in the narrow vessels of the brain where they stop blood flow causing brain infarction or stroke. Oral anticoagulant drugs like warfarin or the newer so called NOAC (new oral anticoagulant) drugs are highly efficient in preventing formation of these large blood clots and offer at least 70% risk reduction. Now, blood clots come in different sizes. There are also microscopic clots that do not cause symptoms of stroke but all the same eat away at the brain at a slow but steady pace. Imaging studies shows this after only a few months or even weeks of atrial fibrillation. Our hypothesis was therefore: If anticoagulants are so effective in protecting against large clots, will they not help against the small ones too?

Continue reading