Title: To Anticoagulate or Not? Stroke Prevention in Atrial Fibrillation Patients with a Single Additional Stroke Risk Factor (P3-5.001)
Authors: Arthur Gribachov, Jamir Pitton Rissardo, Ana Leticia Fornari Caprara, and Vishnu Vardhan Byroju
Conference: 2026 AAN, Chicago, IL
Objective
To compare ischemic stroke (IS) risk between oral anticoagulant (OAC) and no-OAC, and new-oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients with a non-sex-related CHA2DS2-VASc score of 1.
Background
The benefit of OAC in AF patients with a single additional stroke risk factor remains uncertain. Evidence comparing NOACs and VKAs in this intermediate-risk group is limited.
Design/Methods
A systematic PubMed search identified studies evaluating stroke prevention in this population. A meta-analysis of four observational studies (six arms) was performed using Mantel-Haenszel methods. Odds ratios with 95% confidence intervals were pooled under fixed- and random-effects models. Tau estimator: DerSimonian-Laird. Heterogeneity was assessed with I² and Cochran’s Q. Publication bias was evaluated using trim-and-fill and fail-safe N. Subgroup analyses were stratified by follow-up duration.
Results
For OAC versus no-OAC, fixed-effect analysis showed a significant reduction in IS risk (OR 0.78; 95% CI 0.69 to 0.87; p < 0.01), whereas random-effects analysis was nonsignificant (OR 0.82; 95% CI 0.62 to 1.09). Subgroup estimates favored OAC at 1.5-year follow-up (OR 0.69) and 2.5-year follow-up (OR 0.74). For NOAC versus VKA, both fixed-effect and random-effect analyses were non-significant, with similar findings at 1-year (OR 0.50; 95% CI 0.19–1.33) and 2-year (OR 0.65; 95% CI 0.30–1.38) follow-up. Heterogeneity was low for OAC versus no OAC (I² = 1%) but moderate for NOAC versus VKA (I² = 36%).
Conclusions
In AF patients with a single additional stroke risk factor, OAC may reduce IS risk compared with no-OAC, particularly with longer follow-up. NOACs and VKAs appear similarly effective in this population.
Citation
Gribachov A, Rissardo JP, Caprara AL, Byroju VV. To Anticoagulate or Not? Stroke Prevention in Atrial Fibrillation Patients with a Single Additional Stroke Risk Factor (P3-5.001). Neurology 2026;106(11_suppl_1):943. doi: 10.1212/WNL.0000000000213209.
Figure 1. Forest plot comparing oral anticoagulation strategies in atrial fibrillation with CHA₂DS₂-VASc = 1, showing reduced stroke risk with OAC versus no-OAC and no difference between NOACs and VKAs.