Comparison of Non-Vitamin K Antagonist Oral Anticoagulants on Ischemic Stroke and Bleeding

Abstract

Objective: Non-vitamin K antagonist oral anticoagulants (NOACs) have become widely utilized for various clinical indications, including non-valvular atrial fibrillation (NVAF), deep vein thrombosis (DVT), and apical thrombus. Despite their increasing popularity, limited comparative data exist on the clinical outcomes associated with different NOACs. This study aims to address this gap by directly comparing NOACs in terms of ischemic stroke, hemorrhagic stroke, and gastrointestinal bleeding. Materials and Methods: A retrospective search of the electronic database was conducted to identify patients using NOACs for NVAF, DVT, and apical thrombus. Clinical outcomes, including ischemic stroke, hemorrhagic stroke, and gastrointestinal bleeding, were directly compared among different NOACs. The chi-square test and Fisher's exact test were employed to assess the relative incidence of stroke and extracranial complications across four patient groups. Results: Among the 4,112 retrospectively analyzed patients, 55 were included in the study. Demographic and clinical profiles showed no significant differences among patients in the four different drug groups (p > 0.05). Ischemic stroke was observed in 90.9% of the patients, hemorrhagic stroke in 5.8%, and gastrointestinal bleeding in 3.3%. A statistically significant difference was identified between drug doses and the rate of ischemic stroke (p < 0.001). Conclusion: The findings of this retrospective study carry significant implications, especially considering the widespread global use of NOACs. The study revealed no discernible difference in the risk of ischemic stroke among patients using different NOACs. Notably, the risk of hemorrhagic stroke was dose-dependent in the dabigatran group, while rivaroxaban was associated with the highest risk of gastrointestinal bleeding. Given the elevated rate of thromboembolism in patients and the relatively short half-life of NOACs, the study concludes that further optimization of NOAC use is imperative.