Abstract W P344: Choice of Warfarin and Novel Oral Anticoagulants for Secondary Prevention of Stroke/TIA in Japanese NVAF Patients: The SAMURAI-NVAF Study
Purpose: We aimed to determine choice of oral anticoagulants (OACs) at acute hospital discharge in stroke patients with NVAF and clarify their underlying characteristics potentially influencing the choice from a multicenter prospective registry (the SAMURAI-NVAF, NCT01581502).
Methods: 668 acute ischemic stroke/TIA survivors with NVAF (298 women, 77±10 years old) between Sep '11 and Jun '13 were studied; dabigatran (Jan '11), rivaroxaban (Jan '12), and apixaban (Dec '12) were approved for clinical use in NVAF patients in Japan just before or during the periods. OAC choice at hospital discharge (median 23 days) was assessed.
Results: Warfarin was chosen for 420 patients (63%), dabigatran for 143 (21%), rivaroxaban for 72 (11%), and OACs were not chosen for 33 (5%). Of 204 prestroke warfarin users, 160 (78%) continued to take warfarin, 27 changed to dabigatran, and 17 to rivaroxaban. Among three 7-month parts of observation period, warfarin users decreased (70%, 69%, 48%), dabigatran users unchanged (23%, 21%, 19%), and rivaroxaban users increased (0.5%, 7%, 26%). Warfarin users had higher scores of CHADS2 (median 4 in warfarin, 4 in dabigatran, 3 in rivaroxaban, same orders in the following parentheses, p<0.001) and CHA2DS2-VASc (6, 5, 5, p<0.001). Of components for CHA2DS2VASc, congestive heart failure (27%, 12%, 13%, p<0.001), stroke history (29%, 15%, 15%, p=0.001), vascular disease (18%, 11%, 7%, p=0.019), and women (47%, 34%, 40%, p=0.020) were more common in warfarin users than the others. Age (79±10, 73±9, 74±10 years old, p<0.001), body weight (54±12, 62±11, 59±12 kg, p<0.001), admission creatinine clearance (52±26, 72±23, 67±25 ml/min, p<0.001), and concomitant antiplatelet use (12%, 10%, 1%, p=0.020) were also different. As features of index stroke, infarcts >33% in size of the culprit arterial territory were more common (29%, 8%, 13%) and scores of admission NIHSS (median 10, 3, 6), 7-day NIHSS (5, 1, 1) and discharge mRS (3.5, 1, 2, p<0.001 for all) were higher in warfarin users.
Conclusion: In the initial two years after approval of novel OACs (NOACs), warfarin use at acute hospital discharge was still common, although NOAC users gradually increased. Index stroke was milder and ischemia-risk indices were lower in NOAC users than warfarin users.
Author Disclosures: K. Toyoda: Research Grant; Significant; Grants-in-Aid from the Ministry of Health, Labour and Welfare of Japan. Honoraria; Modest; Nippon Boehringer Ingelheim Co. Ltd, Bayer Yakuhin, Ltd.. S. Arihiro: None. K. Todo: None. H. Yamagami: Honoraria; Modest; Nippon Boehringer Ingelheim Co. Ltd, Bayer Yakuhin, Ltd.. K. Kimura: None. Y. Shiokawa: None. K. Kamiyama: None. T. Terasaki: None. Y. Okada: None. Y. Nagakane: None. H. Mochizuki: None. S. Takizawa: None. Y. Hasegawa: None. S. Okuda: None. E. Furui: None. Y. Ito: None. T. Nakashima: None. K. Kario: None. T. Kameda: None. K. Takamatsu: None. K. Nishiyama: None.
- © 2014 by American Heart Association, Inc.