Direct oral anticoagulants compared to aspirin for embolic stroke of undetermined source: A comprehensive meta-analysis

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-02-06 DOI:10.1016/j.jstrokecerebrovasdis.2025.108256

Natalia Arturo M.D. , Aishwarya Koppanatham M.B.B.S. , Paweł Chochoł M.D. , Aisha Rizwan Ahmed M.B.B.S. , Andrei V. Alexandrov MD , Thomas C. Varkey M.D, M.B.A, M.Ed

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引用次数: 0

Abstract

Background

The use of anticoagulation for stroke prevention in embolic stroke of undetermined source (ESUS) is hypothesized to be beneficial over conventional antiplatelet use. However, randomized controlled trials (RCTs) have not found clear benefits, even when assessing cardioembolic enriching features. This study aimed to perform a meta-analysis exploring the efficacy and safety of direct oral anticoagulants (DOACs) following ESUS.

Methods

PubMed, Scopus, and Cochrane Central were systematically searched for studies comparing DOACs versus aspirin after ESUS. The primary outcome was stroke recurrence, and the safety outcome was major bleeding. A random-effects model was used for the analyses. Statistical analysis was performed using Review Manager Web 8.0.0 (RevMan Web).

Results

14,582 patients were included from 9 studies, of which 4 were RCTs. 7,341 (50.3 %) received DOACs as secondary prevention. For stroke recurrence, there was noted non-statistically significant trends towards benefit for DOACs (OR 0.93; 95 % CI 0.81–1.06; p = 0.29; I² = 34 %). No differences were found for major bleeding (HR 1.57; 95 % CI 0.86–2.86; p = 0.15; I² = 63 %). Among the atrial cardiomyopathy subgroup, no benefit was observed (OR 0.88; 95 % CI 0.50–1.55; p = 0.67; I² = 39 %).

Conclusion

There is insufficient evidence to recommend the use of DOACs over aspirin following ESUS for the prevention of stroke recurrence. Nevertheless, the fears of increased bleed risks were also not seen. Further efforts should be directed towards identifying potential embolic sources and the population that benefit from OAC.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.