WSO October 2023 – Issue 1 - 927

1176715
WSO
International Journal of StrokeNam et al.
Research
Effectiveness and safety of secondary
prevention of non-vitamin K oral
anticoagulants use by drug type
in Asian patients
Ki-Woong Nam1,2 , Hyung-Min Kwon1,2, Yong-Seok Lee1,2,
Sung-Ho Won3,4 and Hye-Sung Moon4
International Journal of Stroke
2023, Vol. 18(8) 927 -936
© 2023 World Stroke Organization
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DOI: 10.1177/17474930231176715
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930231176715
Abstract
Background: Although widely used in clinical fields, real-world data on the role of warfarin and non-vitamin K oral
anticoagulants (NOACs) for the secondary prevention of thromboembolic complications in ischemic stroke patients
with nonvalvular atrial fibrillation (NVAF) are scarce.
Aims: This retrospective cohort study compared the effectiveness and safety of secondary prevention of NOAC and
warfarin in ischemic stroke patients with NVAF.
Methods: From the Korean National Health Insurance Service Database, we included 16,762 oral anticoagulants-naive
acute ischemic stroke patients with NVAF between July 2016 and June 2019. The main outcomes included ischemic
stroke, systemic embolism, major bleeding, and all-cause of death.
Results: In total, 1717 warfarin and 15,025 NOAC users were included in the analysis. After 1:8 propensity score
matching, during the observation period, all types of NOACs had a significantly lower risk of ischemic stroke and systemic
embolism than warfarin (edoxaban: adjusted hazard ratio [aHR], 0.80; 95% confidence interval [CI], 0.68-0.93,
rivaroxaban: aHR, 0.82; 95% CI, 0.70-0.96, apixaban: aHR, 0.79; 95% CI, 0.69-0.91, and dabigatran: aHR, 0.82; 95% CI,
0.69-0.97). Edoxaban (aHR, 0.77; 95% CI, 0.62-0.96), apixaban (aHR, 0.73; 95% CI, 0.60-0.90), and dabigatran (aHR,
0.66; 95% CI, 0.51-0.86) had lower risks of major bleeding and all-cause of death.
Conclusions: All NOACs were more effective than warfarin in the secondary prevention of thromboembolic complications
in ischemic stroke patients with NVAF. Except for rivaroxaban, most NOACs demonstrated a lower risk of major
bleeding and all-cause of death than warfarin.
Keywords
Ischemic stroke, atrial fibrillation, oral anticoagulants, prognosis
Received: 13 February 2023; accepted: 8 April 2023
Introduction
1 Department of Neurology, Seoul Metropolitan Government-Seoul
National University Boramae Medical Center, Seoul, Korea
Atrial fibrillation (AF) is a major risk factor for ischemic
stroke and usually causes more severe and fatal strokes
than those caused by other mechanisms.1-3 To prevent the
occurrence (i.e. primary prevention) and recurrence (i.e.
secondary prevention) of stroke in patients with AF, warfarin
has long been used as a standard treatment. However,
long-term use of warfarin within the appropriate therapeutic
range is difficult to maintain, and it increases the risk of
major bleeding.4,5 Non-vitamin K oral anticoagulants
2 Department of Neurology, Seoul National University College of
Medicine, Seoul, Korea
3 Department of Public Health Sciences, Graduate School of Public
Health, Seoul National University, Seoul, Korea
4RexSoft Inc., Seoul, Korea
Corresponding author:
Hyung-Min Kwon, Department of Neurology, Seoul Metropolitan
Government-Seoul National University Boramae Medical Center, 20
Boramae-ro 5-gil, Dongjak-Gu, Seoul 07061, South Korea.
Email: hmkwon@snu.ac.kr
International Journal of Stroke, 18(8)
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WSO October 2023 – Issue 1

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