The Effectiveness of Warfarin Versus Novel Oral Anticoagulants in Preventing Stroke Recurrence

Abstract

To study the effectiveness of warfarin VS novel oral anticoagulants in preventing stroke recurrance with atrial fibrillation ,CSVT and cardio embolic stroke MATERIALS AND METHODS: All the relevant and necessary data will be collected from patients record, lab reports, prescriptions and communicating with health care professionals RESULT:Out of 70 subjects screened according to inclusion and exclusion criteria, 47 were male and 53 were female; these subjects had a history of stroke due to CSVT, cardioembolics, or atrial fibrillation and had responded well to therapy. The research included 48 people who were using NOACs and 24 people who were taking warfarin. CONCLUSION:By summarizing the statistical data of our study we have observed that the total number of patients who were both on warfarin and NOAC\'s have same effectiveness in preventing stroke recurrence . The tolerability of all the drugs is almost same among the study population. The risk of having a recurrent stroke is more in patients with CSVT than that of patients with Atrial fibrillation and cardioembolism. Based on reviewing literatures and reference articles , the studies that have been carried out on NOAC\'s have shown that NOAC\'s are equally effective as warfarin and has an advantage of reduced complications like cerebral bleeding and has a fixed dosage regimen due to these advantages NOAC\'s can be used in place of warfarin. As there are limited number of samples the results may not be yet generalised. Further studies can be carried out on large scale population for more accurate evaluation.

Introduction

I. Stroke in India

• Stroke is the second leading cause of death in India.

• Annually, around 185,000 strokes occur, with one stroke every 40 seconds and one stroke-related death every 4 minutes.

• India accounts for 68.6% of stroke incidence, 70.9% of stroke deaths, and 77.7% of DALYs lost globally.

• Alarming trend: 31% of strokes occur in individuals under 20.

II. Stroke and Recurrence

• Stroke is a vascular brain injury lasting at least 24 hours or resulting in death.

• Recurrent strokes occur after a period of recovery and cause additional damage, increasing risk of disability and mortality.

III. Brain Anatomy

• The brain governs all bodily functions and relies on an intact central nervous system (CNS).

IV. Stroke Classification

• Ischemic Stroke (most common): Caused by blood vessel blockage.

  • Subtypes (TOAST classification): Large-vessel, cardioembolic, small-vessel, undetermined.

• Hemorrhagic Stroke: Caused by blood vessel rupture (27% of cases).

• Transient Ischemic Attack (TIA): Temporary blockage, often a warning sign of an upcoming stroke.

V. Signs and Symptoms

• Sudden symptoms include: facial droop, weakness (one-sided), confusion, speech difficulty, vision problems, headache, and loss of balance.

VI. Risk Factors

• Non-modifiable: Age (risk doubles after 55), genetic predisposition.

• Modifiable: Hypertension, diabetes, coronary artery disease, and previous TIA.

VII. Pathophysiology

• Stroke disrupts oxygen supply, leading to brain cell death (necrosis).

• Ischemic: Caused by emboli (from heart, carotid artery), leading to infarction.

• Hemorrhagic: Causes include hypertension, ruptured aneurysms, drug-induced bleeding.

• Both types cause brain damage via inflammation, oxidative stress, BBB disruption, and energy failure.

VIII. Materials and Methods

• Data sourced from patient records, lab reports, and interactions with healthcare professionals.

• Study focuses on oral anticoagulant therapies (NOACs vs. warfarin) in preventing stroke recurrence.

IX. Statistical Analysis

• Used tests: t-test, Mann-Whitney U, Chi-square, Fisher’s exact.

• Significance set at p < 0.05.

• Analyzed demographics, drug effectiveness, adverse effects, and recurrence risk in patients with conditions like atrial fibrillation, CSVT, and cardioembolic stroke.

X. Results

• 70 patients studied: 47 males, 53 females.

• 48 used NOACs, 24 used warfarin.

• No significant gender-based difference in drug usage (p = 0.175).

• Stroke recurrence observed in:

  • 1/22 with atrial fibrillation (AF)

  • 1/4 with non-AF

  • 2/25 with CSVT

• After recurrence, 50/51 patients continued their prior therapy.

• No significant difference in recurrence rates or drug continuation post-stroke (p-values > 0.05).

Conclusion

By summarizing the statistical data of our study we have observed that the total number of patients who were both on warfarin and NOAC\'s have same effectiveness in preventing stroke recurrence . The tolerability of all the drugs is almost same among the study population. The risk of having a recurrent stroke is more in patients with CSVT than that of patients with Atrial fibrillation and cardioembolism. Based on reviewing literatures and reference articles , the studies that have been carried out on NOAC\'s have shown that NOAC\'s are equally effective as warfarin and has an advantage of reduced complications like cerebral bleeding and has a fixed dosage regimen due to these advantages NOAC\'s can be used in place of warfarin. As there are limited number of samples the results may not be yet generalised. Further studies can be carried out on large scale population for more accurate evaluation.

References

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Copyright

Copyright © 2025 Dr. Anuja Patil, Mohd Saleem, Mogutala Sandhya Rani, Sura Sindhuja, Mrs. Twila Pushpa. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.