Arrhythmias & electrophysiology
Real-World Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Mitral Stenosis : A Target Trial Emulation
Authors' conclusion
In Asian patients with AF-MS, DOACs were associated with an increased 1-year risk for stroke but a decreased risk for MI compared with warfarin.
Study context
- Population
- Patients diagnosed with atrial fibrillation and mitral stenosis (AF-MS) and prescribed either direct oral anticoagulants (DOACs) or warfarin between 1 January 2011 and 31 December 2021
- Exposure
- DOACs versus warfarin
- Outcome
- Ischemic stroke
- Follow-up
- 1-year follow-up
Methodological detailspopulation-wide insurance claims data in Taiwan
- Population-wide insurance claims data in Taiwan
Main finding
As reported in the abstract
DOACs vs warfarinRD, percentage points (95% CI)
Increased risk with DOACs
4.97(1.27–8.57)
DOACs vs warfarinRelative risk (95% CI)
Ischemic stroke
1.22(1.05–1.41)
Observational data: associations, not effects.
Further findings
| Outcome | RD (percentage points) (CI) | |
|---|---|---|
| Composite stroke · 1-year follow-upDOACs vs warfarin · increased risk with DOACs | 5.56 (1.77–8.97) | |
| MI · 1-year follow-upDOACs vs warfarin · decreased risk with DOACs | −1.61 (−3.17 to −0.03) | |
| −50510Difference, percentage points (linear scale) |
| Outcome | RR (CI) | |
|---|---|---|
| Composite stroke · 1-year follow-upDOACs vs warfarin | 1.23 (1.07–1.42) | |
| MI · 1-year follow-upDOACs vs warfarin | 0.61 (0.37–0.99) | |
| 0.20.5125Relative risk (log scale) |
All-cause death
- The 2 groups did not differ in risks for all-cause death
Ischemic stroke with rivaroxaban · short- and long-term follow-up
- Rivaroxaban increased the risk for ischemic stroke during both short- and long-term follow-up periods
Original publication
Real-World Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Mitral Stenosis : A Target Trial Emulation. Ann Intern Med. Published 11 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it