STROKE-VT: DOACs superior to aspirin at stroke prevention af
The STROKE-VT is a multicenter, randomized controlled trial that studied the differences in cerebrovascular events (CVE) between direct oral anticoagulant (DOAC) vs. ASA use post-procedurally in patients undergoing left ventricular arrhythmia (LVA) ablation [ventricular tachycardia (VT) or premature ventricular contraction (PVC)] using radiofrequency ablation (RFA).

246 patients scheduled for LVA-RFA were randomized 1:1 post-procedurally to receive DOAC or ASA. The study’s primary endpoint was the incidence of stroke or TIA, or MRI detected asymptomatic cerebrovascular events (ACE) at 24 hours and 30 days follow-up. The secondary endpoints included procedure-related complications (composite of any vascular complication, pericardial complication, heart block, thromboembolic event excluding stroke or TIA) and in-hospital mortality.

-- There were no differences between groups regarding baseline and ablation characteristics (except the percentage of patients undergoing VT ablation, rate of amiodarone use, and total RFA time).

-- Post-procedure cerebrovascular events (stroke and TIA) were lower in the DOAC arm versus ASA arm (0% vs. 6.5% and 4.9% vs. 18%).

-- Patients in the ASA group had higher MRI detected ACE compared to the DOAC group both at 24 hours (23% vs. 12%) and 30 days (18% vs. 6.5%) follow-up.

-- The acute procedure-related complication and in-hospital mortality were similar between the two groups.

Conclusively, DOAC utilization following endocardial/epicardial ablation for LVA-RFA was associated with reduced risk of transient ischemic attack or stroke, and asymptomatic MRI-detected cerebrovascular event.