JAMA Sub-Journal: How to use anticoagulation and antiplaten in stroke patients caused by embolism?

Regarding recent recurrent strokes in patients with embolic stroke (ESUS) and left ventricular (LV) dysfunction of unknown origin, it is currently uncertain whether anticoagulation is superior to aspirin
.

To determine whether anticoagulant therapy is better than aspirin in reducing recurrent strokes in patients with embolic strokes and left ventricular dysfunction of uncertain origin
.

Experts from the Department of Clinical and Translational Neuroscience of New York University in the United States have carried out relevant research, and the results have been published in the journal JAMA Neurology

JAMA

The researchers conducted an exploratory analysis of data from the new method Rivaroxaban Inhibitor Xa Global Trial and the Aspirin Prevention ESUS Embolism (NAVIGATE ESUS) Trial.
This is a randomized Phase 3 clinical trial from 459 in 31 countries.
The stroke recruitment center recruits patients
.

5 Include patients aged 0 years or older who had ESUS confirmed by neuroimaging within 7 days to 6 months before screening

Stroke prevention screening

Participants were randomly assigned to receive 15 mg rivaroxaban or 100 mg aspirin once a day
.

The main outcome is whether rivaroxaban is superior to aspirin in reducing the following risks: (1) the main result of the trial is recurrent stroke or systemic embolism; (2) the secondary outcome of the trial is recurrent stroke, systemic embolism, myocardial infarction or heart vascular death, the median follow-up time a 10.

Myocardial infarction, heart blood vessels

In the end, 502 participants (7.
1%) developed left ventricular dysfunction
.

Among participants with left ventricular dysfunction, the mean (SD) age was 67 (10) years, and 130 (26%) were female

Among participants with left ventricular dysfunction, the annualized rate of major events assigned to rivaroxaban was 2.

Risk of major outcome events in patients treated with aspirin and rivaroxaban

Risk of major outcome events in patients treated with aspirin and rivaroxaban

Among the 6605 participants without LV dysfunction, those assigned to rivaroxaban (5.
3%; 95% CI, 4.
5-6.
2) and aspirin (4.
5%; 95% CI, 3.
8-5.
3) The ratios are similar
.

Participants with left ventricular dysfunction who were assigned to rivaroxaban had a 64% lower risk of primary outcome (HR=0.

Among the 6605 participants without LV dysfunction, those assigned to rivaroxaban (5.

In summary, rivaroxaban is superior to aspirin in reducing the risk of recurrent stroke or systemic embolism with left ventricular dysfunction

references:

Left Ventricular Dysfunction Among Patients With Embolic Stroke of Undetermined Source and the Effect of Rivaroxaban vs Aspirin: A Subgroup Analysis of the NAVIGATE ESUS Randomized Clinical Trial.

Left Ventricular Dysfunction Among Patients With Embolic Stroke of Undetermined Source and the Effect of Rivaroxaban vs Aspirin: A Subgroup Analysis of the NAVIGATE ESUS Randomized Clinical Trial.
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