Browsing by Autor "Tathiane Gibicoski"

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Abstract 4142748: Direct Oral Anticoagulants Versus Aspirin for Secondary Stroke Prevention in Patients with Embolic Stroke of Undetermined Source: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.
(Lippincott Williams & Wilkins, 2024) Juan Armando Talavera; Larissa Teixeira; Thomaz Alexandre Costa; Denilsa Navalha; Tathiane Gibicoski; Nicole Fernandez; Luciana Armaganijan; Guilherme Dagostin de Carvalho
Background: Embolic stroke of undetermined source (ESUS) represents approximately 20% of ischemic strokes. The optimal treatment strategy for secondary prevention remains uncertain for patients with ESUS. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of direct oral anticoagulants (DOACs) versus aspirin therapy in patients with a history of ESUS. Methods: PubMed, Embase, Cochrane and Web of science databases were systematically searched for eligible trials until March 2024. The primary outcome of interest was recurrent stroke. Major bleeding and clinically relevant non-major bleeding (CRNMB) were assessed as safety outcomes. We pooled hazard rations (HRs) with 95% confidence intervals (CIs) for analysis. Results: Four RCTs comparing direct oral anticoagulants (DOACs) versus aspirin were included comprising 13,970 patients, of whom 6,989 (50%) were randomized to the DOACs group. The mean follow-up was 16 months. Compared to aspirin, DOACs did not reduce the incidence of recurrent stroke (HR: 0.95; 95% CI: 0.81-1.09; p=0.44), ischemic stroke (HR: 0.91; 95% CI: 0.79-1.06; p=0.23), all-cause mortality (HR: 1.11; 95% CI: 0.87-1.42; p=0.40), and major bleeding (HR: 1.56; 95% CI: 0.85%-2.86; p=0.15). However, patients in the DOACs group presented significantly higher incidence of CRNMB (HR: 1.54; 95% CI: 1.23-1.92; p=0.0002) when compared with the aspirin group. Conclusion: Compared with aspirin, DOACs use was associated with an elevated risk of CRNMB and did not demonstrate superior efficacy in preventing recurrent stroke among patients with ESUS. <div class="acfifjfajpekbmhmjppnmmjgmhjkildl" id="acfifjfajpekbmhmjppnmmjgmhjkildl"> </div> <div class="acfifjfajpekbmhmjppnmmjgmhjkildl" id="acfifjfajpekbmhmjppnmmjgmhjkildl"> </div>
Anticoagulantes Orais Diretos versus Aspirina para Prevenção Secundária de Acidente Vascular Cerebral em Pacientes com Acidente Vascular Cerebral Embólico de Fonte Indeterminada: Revisão Sistemática e Metanálise Atualizada de Ensaios Clínicos Randomizados
(Sociedade Brasileira de Cardiologia (SBC), 2025) Juan Armando Talavera; Larissa Teixeira; Teresa Alexandre; Denilsa Navalha; Tathiane Gibicoski; Nicole Fernandez; Jeff S. Healey; Luciana Armaganijan; Guilherme Dagostin de Carvalho
Embolic stroke of undetermined source (ESUS) accounts for around 20% of ischemic strokes. The ideal treatment for secondary prevention in ESUS remains unclear. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of direct oral anticoagulants (DOACs) versus aspirin in patients with ESUS. A systematic search of PubMed, Embase, Cochrane, and Web of Science databases was conducted for eligible trials until March 2024. The primary outcome was recurrent stroke, while safety outcomes included major bleeding and clinically relevant non-major bleeding (CRNMB). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for analysis. Four RCTs were included, involving 13,970 patients, half of whom were randomized to the DOACs group. Over a mean follow-up of 16 months, DOACs did not significantly reduce recurrent stroke (HR: 0.95; 95% CI: 0.81-1.09; p=0.44), ischemic stroke (HR: 0.91; 95% CI: 0.79-1.06; p=0.23), all-cause mortality (HR: 1.11; 95% CI: 0.87-1.42; p=0.40), or major bleeding (HR: 1.56; 95% CI: 0.85%-2.86; p=0.15) compared to aspirin. However, DOACs were associated with a significantly higher risk of CRNMB (HR: 1.54; 95% CI: 1.23-1.92; p=0.0002). Subgroup analysis revealed no significant differences in stroke recurrence among patients with low or high CHA2-DS2-VASc scores. DOACs did not demonstrate superior efficacy over aspirin in preventing recurrent stroke among ESUS patients and were linked to an increased risk of CRNMB.
Direct Oral Anticoagulants versus Aspirin for Secondary Stroke Prevention in Patients with Embolic Stroke of Undetermined Source: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
(Sociedade Brasileira de Cardiologia (SBC), 2025) Juan Armando Talavera; Larissa Teixeira; Teresa Alexandre; Denilsa Navalha; Tathiane Gibicoski; Nicole Fernandez; Jeff S. Healey; Luciana Armaganijan; Guilherme Dagostin de Carvalho
Abstract Embolic stroke of undetermined source (ESUS) accounts for around 20% of ischemic strokes. The ideal treatment for secondary prevention in ESUS remains unclear. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of direct oral anticoagulants (DOACs) versus aspirin in patients with ESUS. A systematic search of PubMed, Embase, Cochrane, and Web of Science databases was conducted for eligible trials until March 2024. The primary outcome was recurrent stroke, while safety outcomes included major bleeding and clinically relevant non-major bleeding (CRNMB). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for analysis. Four RCTs were included, involving 13,970 patients, half of whom were randomized to the DOACs group. Over a mean follow-up of 16 months, DOACs did not significantly reduce recurrent stroke (HR: 0.95; 95% CI: 0.81-1.09; p=0.44), ischemic stroke (HR: 0.91; 95% CI: 0.79-1.06; p=0.23), all-cause mortality (HR: 1.11; 95% CI: 0.87-1.42; p=0.40), or major bleeding (HR: 1.56; 95% CI: 0.85%-2.86; p=0.15) compared to aspirin. However, DOACs were associated with a significantly higher risk of CRNMB (HR: 1.54; 95% CI: 1.23-1.92; p=0.0002). Subgroup analysis revealed no significant differences in stroke recurrence among patients with low or high CHA2-DS2-VASc scores. DOACs did not demonstrate superior efficacy over aspirin in preventing recurrent stroke among ESUS patients and were linked to an increased risk of CRNMB.