José Fernández Ferro
Inmaculada Navas Vinagre
Gerardo Ruiz Ares
Background and Aims: After the development of the novel oral anticoagulants (NOAC) for stroke prevention, prospective registries to evaluate the results of their implementation in clinical practice are mainly based on primary prevention. Our aim is to explore the long-term outcomes differences according to the oral anticoagulation (OAC) in secondary stroke prevention. Methods: A prospective, multicentric, registry including IS patients who were discharged under OAC. Three months follow-up was scheduled at outpatient clinic with subsequent annual phone interviews for 3 years. Principal outcomes: stroke recurrences, intracranial hemorrhage, mayor hemorrhage and mortality. Patients were classified and compared into 4 study groups according to OAC at discharge: Vitamin K antagonist (AVK), Factor Xa inhibitor (FXa-I), direct thrombin inhibitor (DTI) and non-OAC. Results: 256 patients were included. Patients under FXa-I were older (age >75: 47.9% vs. 22.2% AVK, 14.5% DTI and 15.4% other OAC P=.001), had higher frequency of hypertension (40% vs. 29% AVK, 15% DTI and 14 % other OAC P=.006), had higher CHA2DS2-VASc (median 6 vs. 5 in all the other groups; P=.001) and HASBLED scores (median 3 vs. 2 in the other groups; P=.02). We found low mortality rates (3 death/year), stroke recurrences (5.6 stroke/year), intracranial hemorrhages (0.6 hemorrhage/year) and major hemorrhages (0.6 hemorrhage/year) for the first year, without differences according to the type of OAC. For the second and third year, no intracranial hemorrhages were reported and the incidence rate decline to 0.05 stroke/year. Conclusions: Stroke secondary prevention with OAC is safe without significant differences in stroke recurrence rates at long-term between anticoagulant treatments.
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