Abstract Details

Title Comparative Effectiveness of Direct Oral Anticoagulants and Warfarin in Reduced Ejection Fraction After Stroke (CEDAR)

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Innovations in Cerebrovascular Therapy (4:06 PM-4:18 PM)

Poster/Presentation
Number 004

Objective To compare the effectiveness and safety of direct oral anticoagulants (DOACs) versus warfarin for secondary stroke prevention in patients with LVEF ≤30%.

Background

The optimal anticoagulant for secondary stroke prevention in patients with reduced left ventricular ejection fraction (LVEF ≤30%) remains uncertain. This study aimed to compare the effectiveness and safety of direct oral anticoagulants (DOACs) versus warfarin for secondary stroke prevention in patients with LVEF ≤30%.

Design/Methods We conducted a multicenter retrospective cohort study across 15 U.S. sites from 2016 to 2022. Patients with LVEF ≤30% following ischemic stroke (IS) who received either DOACs or warfarin were included; those on any antiplatelet regimen prior to any outcome event were excluded. The primary outcome was a composite of recurrent IS and all-cause mortality. The secondary outcome was a composite of intracranial hemorrhage and major extracranial bleeding. Inverse propensity-score weighted Cox proportional hazards models adjusted for demographics, comorbidities, and treatment imbalances. Pooled models with interaction terms assessed modification of treatment effects by left ventricular thrombus (LVT) status.

Results Of 771 screened patients, 370 met inclusion criteria (264 [71.4%] DOACs; 106 [28.6%] warfarin). The annualized incidence of recurrent stroke was 5.94 per 100 patient-years for DOACs and 2.93 for warfarin. Mortality rates were similar (11.53 vs 11.56 per 100 patient-years). Adjusted analyses showed no significant difference in the primary composite outcome for DOACs versus warfarin (HR 1.09, 95% CI 0.62-1.93, p=0.75), nor in bleeding or intracranial hemorrhage. Bootstrap analyses confirmed the stability of these findings.

Conclusions DOACs demonstrated comparable effectiveness and safety to warfarin for secondary stroke prevention in patients with LVEF ≤30%, supporting their use as a reasonable alternative in this population.

Authors/Disclosures
Rami Morsi, MD (University of Chicago) PRESENTER	Dr. Morsi has nothing to disclose.
Elena Badillo-Goicoechea, MS	Ms. Badillo-Goicoechea has nothing to disclose.
Ahmad Chahine, MD	Dr. Chahine has nothing to disclose.
Yee K. Cheng, MD	Dr. Cheng has nothing to disclose.
Mehdi Abbasi (Neurology Dept.)	No disclosure on file
Adeel Zubair, MD (Yale University School of Medicine)	Dr. Zubair has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The MedNet.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has or had stock in Certus.Dr. De Havenon has or had stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Ian Yahnke, MD (University of Cincinnati)	Dr. Yahnke has nothing to disclose.
Bryce Casteigne, MD	Dr. Casteigne has nothing to disclose.
Yasmin Aziz, MD (UC Neurology)	Dr. Aziz has nothing to disclose.
Tiffany A. Brown, MD	Dr. Brown has nothing to disclose.
Setareh Salehi Omran, MD (University of Colorado)	Dr. Salehi Omran has nothing to disclose.
Raman Singh, MD, MBBS	Dr. Singh has nothing to disclose.
Maryam Haq, MD (University of Oklahoma)	Dr. Haq has nothing to disclose.
Faddi G. Saleh Velez, MD (University of oklahoma health Sciences center)	Dr. Saleh Velez has nothing to disclose.
Anne Coogan, MD (Vanderbilt University Medical Center)	Dr. Coogan has nothing to disclose.
Tamer G. Ghanayem, MD (Vanderbilt University Medical Center)	Dr. Ghanayem has nothing to disclose.
Deborah Kerrigan, MD (Vanderbilt University Medical Center)	An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Terumo. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbott. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abiomed. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Agepha. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AngioInsignts. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Asahi. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biotronik. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Boston Scientific. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Chiesi. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cordis. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Heartflow. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Imperative Care. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ischemiaview Inc.. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Kardion. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Kaniksa. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merit. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Philips. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Siemens. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Shockwave. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teleflex. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Zed. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Zoll. Dr. Kerrigan has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abiomed. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Agepha. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AngioInsights. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Asahi. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biotronik. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cordis. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Heartflow. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Imperative Care. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ischemiaview Inc. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kardion. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kiniksa. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merit. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Philips. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Siemens. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shockwave. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teleflex. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Terumo. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zed. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbott. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abiomed. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Agepha. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AngioInsights. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Asahi. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biotronik. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Boston Scientific. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Chiesi. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Cordis. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Heartflow. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Imperative Care. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Ischemiaview Inc. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Kardion. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Kiniksa. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Medtronic. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Merit. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Penumbra. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Philips. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Siemens. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Shockwave. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teleflex. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Terumo. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Zed. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Zoll. An immediate family member of Dr. Kerrigan has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Individual attorneys. The institution of an immediate family member of Dr. Kerrigan has received research support from Abiomed. The institution of an immediate family member of Dr. Kerrigan has received research support from Amgen. The institution of an immediate family member of Dr. Kerrigan has received research support from Inari. The institution of an immediate family member of Dr. Kerrigan has received research support from InfraredX. The institution of an immediate family member of Dr. Kerrigan has received research support from Janssen. The institution of an immediate family member of Dr. Kerrigan has received research support from Kardion. The institution of an immediate family member of Dr. Kerrigan has received research support from Novo Nordisk. The institution of an immediate family member of Dr. Kerrigan has received research support from Philips. The institution of an immediate family member of Dr. Kerrigan has received research support from Recor.
Liqi Shu, MD (Brown Neurology)	Dr. Shu has nothing to disclose.
Daniel Mandel, MD	Dr. Mandel has nothing to disclose.
Dalia Chahien, MS	Dr. Chahien has nothing to disclose.
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology)	The institution of Dr. Stretz has received research support from American Heart Association. The institution of Dr. Stretz has received research support from Duke University Medical Center/NIH. The institution of Dr. Stretz has received research support from University of Cincinnati/NINDS.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Farid Khasiyev, MD (SLUCare Academic Pavilion, Department of Neurology)	Dr. Khasiyev has nothing to disclose.
Guillermo Linares, MD	Dr. Linares has nothing to disclose.
Y. Andrea Arevalo C, MD (University of Alabama at Birmingham)	Dr. Arevalo C has nothing to disclose.
Ekaterina Bakradze, MD (University of Alabama At Birmingham)	Dr. Bakradze has nothing to disclose.
Isobel MacKenzie, MD (Washington University School of Medicine, Neurology Department)	Ms. MacKenzie has nothing to disclose.
Mohammad Khasawneh, MD (Washington University School of Medicine, Neurology Department)	Dr. Khasawneh has nothing to disclose.
Fatih C. Koc, MD (Washington University in St Louis, Department of Neurology)	Dr. Koc has nothing to disclose.
Meghna Hegde, MBBS (KUMC)	Dr. Nambakkam has nothing to disclose.
Abid Qureshi, MD (University of Kansas Medical Center)	Dr. Qureshi has nothing to disclose.
Ana Herning (Boston Medical Center)	No disclosure on file
Piers Klein	Mr. Klein has nothing to disclose.
Thanh Nguyen, MD	Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vesalio. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avania. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Nguyen has received research support from Boston Medical Center. The institution of Dr. Nguyen has received research support from Society of Vascular and Interventional Neurology.
Muhammad Rizwan Husain, MD	Dr. Husain has nothing to disclose.
Umer Rizwan (West Virginia University Health Sciences)	No disclosure on file
Aaron Rothstein, MD	Dr. Rothstein has received personal compensation in the range of $500-$4,999 for serving as a Writer with National Affairs. Dr. Rothstein has received personal compensation in the range of $0-$499 for serving as a Writer with Public Discourse.
Jens Witsch, MD (University of Pennsylvania)	Dr. Witsch has a non-compensated relationship as a editorial team member with Neurology Reisdent & Fellow section that is relevant to AAN interests or activities.
Donna George, MD (University of Pennsylvania)	Dr. George has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. George has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Kane, Pugh, Knoell, Troy & Kramer LLP.
Issam Awad, MD	No disclosure on file
Sonam Thind (University of Chicago)	No disclosure on file
Atman Shah (University of Chicago)	No disclosure on file
Sandeep Nathan (University of Chicago)	No disclosure on file
Elisheva R. Coleman, MD (University of Chicago Medical Center)	Dr. Coleman has nothing to disclose.
James R. Brorson, MD (University of Chicago)	Dr. Brorson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for National Peer Review Corporation. Dr. Brorson has a non-compensated relationship as a Vascular Neurology Pilot Committee with American Board of Psychiatry and Neurology that is relevant to AAN interests or activities.
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.
Ali Mansour, MD (University of Chicago)	Dr. Mansour has nothing to disclose.
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.
Tareq Kass-Hout, MD (Jackson Memorial Hospital)	Dr. Kass-Hout has nothing to disclose.

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