Masafumi Ihara (Japan)
National Cerebral and Cardiovascular Center Department of NeurologyAuthor Of 1 Presentation
LONG-TERM OUTCOME BETWEEN DIRECT ORAL ANTICOAGULANTS THERAPY AND ANTIPLATELET THERAPY AFTER PATENT FORAMEN OVALE-ASSOCIATED STROKE
- Takeshi Yoshimoto (Japan)
Abstract
Background and Aims:
We aimed to clarify the long-term outcome of warfarin, direct oral anticoagulants (DOACs), or antiplatelet drugs for patent foramen ovale (PFO)-associated stroke.
Methods:
Consecutive PFO-associated stroke patients within six months were included from our single-center prospective database from November 2010 to April 2020. Patients with PFO closure were excluded. Subjects were divided into three subgroups by antithrombotic drugs (warfarin, DOAC, antiplatelet drug ). Each incidence rate for the composite event of recurrence ischemic stroke (IS) / cardiovascular death / major bleeding between groups using the Kaplan-Meier method. The hazard ratio (HR) adjusted for age and gender was analyzed from the Cox proportional hazard model.
Results:
The subjects were 231 patients (38% female, mean age ± standard deviation 74 ± 15 years), and the median observation period (IQR) was 2.3 (1.0–4.2) years. Annual incidence of complex events is warfarin 13 cases / 274 person-years (4.7%), DOAC 4 cases / 112 person-years (3.6%; adjusted hazard ratio [aHR] [95% confidence interval (CI)], 0.78 [0.28–2.33]), antiplatelet drugs 28 cases / 276 man-years (10.1%; aHR [95% CI], 2.11 [1.05–4.22]). In PFO-associated stroke high-risk cases (n=92), the annual incidence of compound events was warfarin 7 cases / 92 person-years (7.6%), DOAC 1 case / 42 person-years (2.4%; 0.34 [0.07–6.31]), 16 antiplatelet drugs / 86 man-years (18.6%; 2.11 [1.05–4.22]).
Conclusions:
The annual incidence of compound events in the patients with PFO-associated stroke and the high-risk PFO-associated stroke was significantly higher in antiplatelet drug cases than in warfarin cases.