title: Acenocoumarol vs. low-dose dabigatran in real-world patients discharged after ischemic stroke.
abstract: The aim of this study was to compare the efficacy of dabigatran 110 mg twice daily and acenocoumarol in patients with atrial fibrillation discharged after ischemic stroke. We prospectively studied 436 consecutive patients who were discharged after acute ischemic stroke (39.2% males, age 78.6 ± 6.7 years). Approximately 1 year after discharge, the functional status was assessed with the modified Rankin scale (mRS). Adverse outcome was defined as mRS between 2 and 6. The occurrence of ischemic stroke, myocardial infarction (MI) and death during the 1-year follow-up was also recorded. At discharge, 142 patients had atrial fibrillation. Acenocoumarol and dabigatran 110 mg twice daily were prescribed to 52.1 and 6.3% of these patients, respectively. At 1 year after discharge, there was a trend for patients treated with acenocoumarol to have lower mRS than patients prescribed dabigatran (2.3 ± 2.4 and 4.1 ± 2.2, respectively; P = 0.060). Adverse outcome rates and the incidence of stroke during follow-up did not differ between the two groups. The incidence of MI was almost three times higher in patients prescribed dabigatran than in those prescribed acenocoumarol, but this difference did not reach significance (11.1 and 4.0%, respectively; P = 0.254). The incidence of cardiovascular death was also almost three times higher in the former, but again this difference was not significant (33.3 and 12.2%, respectively; P = 0.237). In real-world patients with acute ischemic stroke, dabigatran 110 mg twice daily is as effective as acenocoumarol in preventing stroke but appears to be associated with worse long-term functional outcome and higher incidence of MI.
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tziomalos
authors.forename: Vasilios
authors.initials: V
authors.lastname: Giampatzis
authors.forename: Stella D
authors.initials: SD
authors.lastname: Bouziana
authors.forename: Marianna
authors.initials: M
authors.lastname: Spanou
authors.forename: Stavroula
authors.initials: S
authors.lastname: Kostaki
authors.forename: Maria
authors.initials: M
authors.lastname: Papadopoulou
authors.forename: Stella-Maria
authors.initials: SM
authors.lastname: Angelopoulou
authors.forename: Filitsa
authors.initials: F
authors.lastname: Konstantara
authors.forename: Christos
authors.initials: C
authors.lastname: Savopoulos
authors.forename: Apostolos I
authors.initials: AI
authors.lastname: Hatzitolios
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D000069604:Dabigatran / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D010351:Patient Discharge; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D013927:Thrombosis / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000517:prevention & control
chemical_list: D000991:Antithrombins; D000069604:Dabigatran; D000074:Acenocoumarol