New study compares different approaches for stroke prevention in patients with non-valvular atrial fibrillation

October 25, 2016 by Adam Pope, University of Alabama at Birmingham

A recent study from University of Alabama at Birmingham researchers published in PLOS ONE compares different available treatments for stroke prevention in patients with non-valvular atrial fibrillation.

The group identified six with 59,627 patients comparing six different FDA-approved treatment alternatives. The study combined all phase-three randomized controlled clinical trials comparing different novel oral blood thinners, left atrial appendage closure devices, known as WATCHMAN devices, and Coumadin (warfarin) for in patients with non-valvular atrial fibrillation. Investigators reported data on ischemic stroke, major bleeding and primary safety endpoint from these clinical trials.

WATCHMAN left atrial appendage devices are used as an alternative to long-term warfarin therapy for stroke risk-reduction patients with non-valvular atrial fibrillation.

UAB doctors say too many options may not be a good thing.

"The occurrence of multiple treatment pathways has presented dilemmas for the clinicians," said Navkaranbir S. Bajaj, M.D., the first author of the PLOS ONE study who designed and conducted the analyses for the study.

"We exploited the fact that no direct comparisons from trials were available between WATCHMAN and novel oral anti-coagulants," said Bajaj, instructor fellow in the division of .

The study explains that, while direct evidence from is lacking, indirect comparisons using systematic network meta-analyses can provide useful complementary information that may be less biased than the direct evidence.

Researchers have found that all treatments had comparable efficacy in reducing stroke rates. However, Apixaban, one of the novel oral blood thinners, was a clear winner in terms of safety profile, and the WATCHMAN device was ranked last due to a higher number of procedural adverse events.

"In an era of precision medicine, we need to individualize treatment for our patients," said senior author Pankaj Arora, M.D., assistant professor in the Division of Cardiovascular Disease. "Our current analysis gives insight into how one can do that to prevent stroke in patients with atrial fibrillation."

Arora says one size does not fit all, and his clinical translational research group is actively working to apply this order to all cardiovascular diseases. The authors concluded that the trade-off between safety and efficacy should be the driving force, and the hierarchical ranking presented in this paper can serve as a clinical tool to guide selection of therapy in patients with atrial fibrillation.

Explore further: Short episodes of abnormal heart rhythm may not increase risk of stroke

More information: Navkaranbir S. Bajaj et al. Comparison of Approaches for Stroke Prophylaxis in Patients with Non-Valvular Atrial Fibrillation: Network Meta-Analyses of Randomized Controlled Trials, PLOS ONE (2016). DOI: 10.1371/journal.pone.0163608

Related Stories

Short episodes of abnormal heart rhythm may not increase risk of stroke

October 17, 2016
People with pacemakers or defibrillators who experience only short episodes of an abnormal heart rhythm known as atrial fibrillation have a very low risk of stroke, suggesting that anticoagulants in this group of patients ...

How safe and effective are new drugs for stroke prevention?

October 3, 2016
For decades, warfarin was the only oral blood thinner available to reduce the risk of stroke for patients with atrial fibrillation. Warfarin use is cumbersome, because it requires ongoing blood test to monitor the effect ...

New oral anticoagulants provide same stroke prevention as warfarin but cause less bleeding

August 27, 2016
The new oral anticoagulants provide the same stroke prevention as warfarin but cause less intracranial bleeding, reports an observational study in more than 43 000 patients presented at ESC Congress 2016 today by Dr Laila ...

Alcohol-related hospitalization associated with doubled stroke risk in atrial fibrillation

August 27, 2016
Alcohol related hospitalisation is associated with a doubled risk of ischaemic stroke risk in patients with non-valvular atrial fibrillation, according to a study presented at ESC Congress 2016 today by Dr Faris Al-Khalili, ...

Team demonstrates cost-effectiveness of Watchman device

December 21, 2015
The WATCHMAN Left Atrial Appendage Closure Device is more cost-effective than warfarin and non-warfarin oral anticoagulants (NOACs) for stroke reduction in patients with non-valvular atrial fibrillation, according to a study ...

Societies issue recommendations for left atrial appendage occlusion

June 29, 2015
The American College of Cardiology, Heart Rhythm Society and Society for Cardiovascular Angiography and Interventions today released a new overview on the implantation of left atrial appendage occlusion devices.

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.