Patients | Preventive strategy | Composite outcome | Recurrent ischaemic stroke | ||||||||||
Unadjusted | Adjusted* | Unadjusted | Adjusted* | ||||||||||
OR (95%, CI) | P value | N events/total N in model | aOR (95%, CI) | P value | N events/total N in model | OR (95%, CI) | P value | N events/ total N in model | aOR (95%, CI) | P value | N events/ total N in model | ||
All patients | Use of DOAC (vs VKA) after stroke | 0.49 (0.34 to 0.71) | <0.001 | 194/1498 | 0.49 (0.32 to 0.73) | <0.001 | 179/1394 | 0.51 (0.29 to 0.90) | 0.020 | 69/1489 | 0.44 (0.24 to 0.80) | 0.007 | 62/1368 |
Any anticoagulant switch | 0.71(0.52 to 0.96) | 0.024 | 194/1498 | 0.69 (0.49 to 0.96) | 0.026 | 179/1394 | 1.03 (0.62 to 1.69) | 0.916 | 69/1489 | 1.03 (0.60 to 1.77) | 0.909 | 62/1368 | |
Addition of antiplatelets | 1.34 (0.89 to 2.03) | 0.164 | 251/1564 | 1.99(1.25 to 3.15) | 0.004 | 225/1448 | 2.38 (1.31 to 4.32) | 0.004 | 69/1505 | 2.66 (1.40 to 5.04) | 0.003 | 62/1382 | |
Patients with DOAC at the time of the stroke | Switch to another DOAC | 0.83 (0.54 to 1.27) | 0.380 | 94/829 | 0.81(0.51 to 1.29) | 0.372 | 86/761 | 1.76 (0.89 to 3.47) | 0.105 | 39/826 | 1.87 (0.88 to 3.99) | 0.105 | 33/757 |
Switch to DOAC with different dosing frequency | 0.65 (0.41 to 1.03) | 0.069 | 89/798 | 0.60 (0.36 to 1.00) | 0.051 | 81/730 | 1.31 (0.67 to 2.58) | 0.436 | 35/794 | 1.38 (0.64 to 2.98) | 0.410 | 29/725 | |
Switch to DOAC with different mechanism of action | 0.91 (0.55 to 1.52) | 0.722 | 89/799 | 1.00 (0.57 to 1.76) | 0.994 | 81/731 | 2.17 (1.09 to 4.33) | 0.027 | 35/795 | 2.12 (0.96 to 4.69) | 0.063 | 29/726 | |
Patients with VKA at the time of the stroke | Switch to any DOAC | 0.51 (0.33 to 0.79) | 0.002 | 100/669 | 0.55 (0.33 to 0.91) | 0.019 | 93/621 | 0.50 (0.24 to 1.06) | 0.070 | 30/663 | 0.56 (0.25 to 1.29) | 0.174 | 29/611 |
Patients with competing stroke mechanism | Addition of antiplatelets | 1.02 (0.56 to 1.87) | 0.936 | 70/414 | 1.88 (0.93 to 3.83) | 0.080 | 63/361 | 1.83 (0.84 to 3.99) | 0.128 | 30/409 | 2.19 (0.92 to 5.21) | 0.075 | 27/359 |
Patients with insufficient anticoagulation | Switch to DOAC or correct DOAC dose | 0.84 (0.50 to 1.41) | 0.501 | 69/498 | 1.05 (0.58 to 1.90) | 0.874 | 62/467 | 0.87 (0.33 to 2.32) | 0.778 | 17/480 | 1.05 (0.35 to 3.12) | 0.930 | 16/402 |
Patients with cardioembolism despite sufficient anticoagulation | Two times per day DOAC (vs any other anticoagulant) | 0.29 (0.18 to 0.45) | <0.001 | 96/617 | 0.55 (0.31 to 0.97) | 0.039 | 86/576 | 2.20 (0.64 to 7.56) | 0.212 | 21/592 | 2.02 (0.53 to 7.69) | 0.305 | 18/555 |
*Adjusted for age, sex, hypertension, diabetes, ischaemic heart disease, dyslipidaemia, renal impairment, prior ischaemic stroke, intracranial haemorrhage, current smoking, active malignancy, use of statins, use of antihypertensives.
.aOR, adjusted OR; DOAC, direct oral anticoagulant; VKA, vitamin K-antagonist.