Abstract 4369165: Direct Oral Anticoagulants Do Not Prevent Stroke in Atrial Fibrillation Patients with Prior Intracerebral Hemorrhage: A Meta-analysis of Randomized Controlled Trials

Backround: There is uncertainty regarding the safety and efficacy of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with a prior history of intracerebral hemorrhage (ICH) Objectives: We aimed to perform an updated meta-analysis exploring the safety and efficacy of using DOACs versus no anticoagulation in AF patients with a prior history of ICH. Methods: We searched PUBMED, Embase and Cochrane Central for studies comparing DOACs versus no anticoagulation in patients with AF and prior ICH. The main outcomes were ischemic stroke and recurrence of ICH. Statistical analysis was performed using Review Manager Web. Heterogeneity was assessed using I 2 statistics Results: The analysis includes 623 patients from 3 RCTs. 309 (49.6%) patients received DOACs. There was no significant difference in ischemic stroke (RR 0.52; 95% CI 0.07-3.93; p = 0.53; I2 = 86%), all-cause mortality (RR 0.85; 95% CI 0.52-1.40; p = 0.53; I2 = 0%), or rates of recurrent ICH (RR 1.44; 95% CI 0.27-7.70; p = 0.67; I2 = 81%) in patients treated with DOACs compared with those managed with no anticoagulation. Conclusion: This meta-analysis of 3 RCTs has not shown a difference in ischemic stroke, recurrence of intracerebral hemorrhage or all-cause mortality in patients with AF and a history of ICH treated with DOACs as compared with no anticoagulation