J Neurol. 2026 Feb 3;273(2):113. doi: 10.1007/s00415-026-13635-1.
ABSTRACT
AIMS: Rivaroxaban has been approved for the primary prevention of stroke with non-valvular atrial fibrillation caused by one or more risk factors. However, the optimal antithrombotic therapy for secondary prevention of stroke in atrial fibrillation (AF) with ischemic stroke/transient ischemic attack (TIA) had been uncertain. We compared the safety and efficacy of novel oral anticoagulants. (NOACs) and Warfarin in treating AF with ischemic stroke.
METHODS: Seven databases were searched from inception up to December 2024 for studies comparing NOACs and Warfarin in AF with ischemic stroke. 7 randomized controlled trials (RCTs) and 9 cohort studies with 128,808 patients were included. A random-effects model or fix effects model was used.
RESULTS: Pooled results showed that the NOACs are superior to Warfarin in the prevention of stroke or systemic embolism (RR 0.90, 95%CI [0.82,1.0], P = 0.04) and all-cause mortality (RR 0.83, 95%CI [0.76,0.92], P = 0.0003). As well as NOACs has lower risk in total bleeding (RR 0.79, 95%CI [0.76,0.83], P < 0.00001), fatal bleeding (RR0.64, 95% CI [0.54,0.76], P < 0.00001), hemorrhagic stroke (RR0.50, 95%CI [0.43,0.58], P < 0.00001), and intracranial bleeding (RR 0.49, 95%CI [0.36,0.65], P < 0.00001) than Warfarin.
CONCLUSION: In the secondary prevention with AF related to ischemic stroke, NOACs showed potential advantages over Warfarin in the incidence of stroke or systemic embolism, all-cause mortality, total bleeding, fatal bleeding, hemorrhagic stroke, and intracranial bleeding.
PMID:41632318 | DOI:10.1007/s00415-026-13635-1