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September 10, 2025Circulation Cardiovascular Quality and OutcomesOpen Access

Estimating the Stroke Risk Threshold for Initiating Non-Vitamin K Antagonist Oral Anticoagulation in Atrial Fibrillation: Markov Decision Model Analysis

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Authors

AWAleksi K. WinsténVLVille L. LangénJAJuhani Airaksinen

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Overview

Markov decision model estimates QALY impact of DOACs on stroke risk in atrial fibrillation patients, indicating a threshold for benefits.

Key Points

  • Initiating DOACs improves QALYs for atrial fibrillation patients with an annual stroke risk above 0.65%.
  • At stroke risks of 1%, 2%, and 3%, mean QALY gains with DOACs were 0.13, 0.53, and 1.00 per patient, respectively.
  • The study utilized a Markov decision model over a 20-year horizon to assess the impact of anticoagulation therapy.
  • Findings suggest that patients with low ischemic stroke risk (below 0.65%) may not benefit from DOAC therapy.

Cite This Study

Winstén et al. (2025) studied this question.

synapsesocial.com/papers/68c24364b210217d647a673ahttps://doi.org/10.1161/circoutcomes.125.012090
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cost-effectiveness of oral anticoagulant therapy in patients with device-detected atrial fibrillation2026
  2. 2Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk2026
  3. 3Does the effect of anticoagulation on stroke risk differ by CHA2DS2-VA score in patients with atrial fibrillation? A nationwide cohort study2026
  4. 42188-P: Clinical Benefits and Risks of Reduced-Dose vs. Standard-Dose Direct Oral Anticoagulants in Patients with Atrial Fibrillation: An Observational Analysis of Veterans Affairs Data2026
  5. 5Impact of Direct Oral Anticoagulant Uptake on Hospitalizations for Stroke/Transient Ischemic Attack, Intracranial Hemorrhage, and Gastrointestinal Bleeding in Individuals With Atrial Fibrillation: A Population‐Based Study2025 · 3 citations