- 著者
-
Sohei Yoshimura
Masatoshi Koga
Shoichiro Sato
Kenichi Todo
Hiroshi Yamagami
Masaya Kumamoto
Ryo Itabashi
Tadashi Terasaki
Kazumi Kimura
Yoshiki Yagita
Yoshiaki Shiokawa
Kenji Kamiyama
Satoshi Okuda
Yasushi Okada
Shunya Takizawa
Yasuhiro Hasegawa
Tomoaki Kameda
Satoshi Shibuya
Yoshinari Nagakane
Yasuhiro Ito
Hideki Matsuoka
Kazuhiro Takamatsu
Kazutoshi Nishiyama
Kyohei Fujita
Teppei Kamimura
Daisuke Ando
Toshihiro Ide
Takeshi Yoshimoto
Masayuki Shiozawa
Soichiro Matsubara
Yoshitaka Yamaguchi
Naoto Kinoshita
Takayuki Matsuki
Junji Takasugi
Keisuke Tokunaga
Kyoko Higashida
Kazunari Homma
Kazuomi Kario
Shoji Arihiro
Kazunori Toyoda
for the SAMURAI Study Investigators
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-18-0067, (Released:2018-06-01)
- 参考文献数
- 27
- 被引用文献数
-
34
Background:We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry in Japan.Methods and Results:NVAF patients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS2and discharge modified Rankin Scale scores than warfarin users (P<0.0001 each). Incidences of stroke/systemic embolism (adjusted hazard ratio, 1.07; 95% CI, 0.66–1.72), all ischemic events (1.13; 0.72–1.75), and ischemic stroke/TIA (1.58; 0.95–2.62) were similar between groups. Risks of intracranial hemorrhage (0.32; 0.09–0.97) and death (0.41; 0.26–0.63) were significantly lower for DOAC users. Infection was the leading cause of death, accounting for 40% of deaths among warfarin users.Conclusions:Stroke/TIA patients receiving DOACs for secondary prevention were younger and had lower stroke severity and risk indices than those receiving warfarin. Estimated cumulative incidences of stroke and systemic embolism within 2 years were similar between warfarin and DOACs users, but those of death and intracranial hemorrhage were significantly lower among DOAC users.