NOACs Safer in AF with Prior ICH

A cohort study in Taiwan suggested that among patients with atrial fibrillation (AF) with prior ICH, non–vitamin K antagonist oral anticoagulants (NOACs) use was associated with lower rates of intracranial hemorrhage (ICH) and major bleeding compared with warfarin use, whereas the rate of ischemic stroke was similar. The study included 4540 patients (mean age, 76.0 years; 58.4% men), with 1047 patients receiving warfarin (mean age, 75.1 years; 54.5% men) and 3493 patients receiving NOACs (mean age, 76.3 years; 59.6% men). Compared with warfarin use, NOACs use was associated with statistically significantly lower risk of all-cause mortality (adjusted hazard ratio [aHR], 0.517), ICH (aHR, 0.556), and major bleeding (aHR, 0.645), whereas the rate of ischemic stroke was similar in the 2 groups (aHR, 0.879). The results were generally consistent after propensity score matching among 973 patients in each group. The findings suggest that NOACs could be the preferred choice for stroke prevention in AF patients with prior ICH. Source: https://zh.jamanetwork.com/