ABSTRACT NUMBER: ESOC2026LT49 EFFICACY OF DIRECT ORAL ANTICOAGULANTS IN ISCHEMIC STROKE IN CHAGAS DISEASE: A REAL-WORLD MULTICENTER COHORT

Abstract Background and aims Direct oral anticoagulants (DOACs) are increasingly used in cardioembolic ischemic stroke (IS). In Brazil, Chagas disease is an important cause of IS, but the safety and efficacy of DOACs in this population remains uncertain. We compared efficacy and safety of antithrombotic therapies (DOACs, antiplatelets or warfarin) in Chagas disease-associated IS. Methods Multicenter cohort with clinical and radiological diagnosis of IS and positive Chagas disease serology. Primary efficacy outcome was IS recurrence and safety outcomes were systemic/intracranial hemorrhage or death. Baseline characteristics were compared between antithrombotic therapies and cause-specific Cox regression was used to compare event rates. Results A total 246 patients were included, mean age 66.9 ± 13.5 years; 57 (23.2%) used DOACs, 56 (22.8%) warfarin, and 133 (54.1%) antiplatelets. Stroke recurrence rates per 100 patient-years were 6.3 for DOACs, 5.8 for warfarin and 3.3 for antiplatelets (log-rank p=0.290). In multivariable analysis, there was no significant difference in stroke recurrence between DOACs and antiplatelets (p=0.124) or between warfarin and antiplatelets (p=0.341). However, anticoagulants showed lower risk of death per 100 patient-years (4.5 for antiplatelets, 1.3 DOACs and 0.7 warfarin, p=0.003). Multivariable comparison remained significant for warfarin versus antiplatelets (HR=0.11, p=0.031). Hemorrhagic complications occurred at a rate of 1.2 per 100 patient-years and were similar across the three groups (p=0.920). Conclusions DOACs appear to be safe and as effective as other antithrombotic therapies in preventing recurrent ischemic stroke in patients with Chagas disease. Anticoagulants showed similar hemorrhagic risk compared with antiplatelets and were associated with lower risk of death. Conflict of interest Figure 1 - belongs to Results