Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Atrial Fibrillation

Jin, Myung; Choi, Eue Keun; Han, Kyung Do; Lee, So‐Ryoung; Lim, Woo Hyun; Oh, Seil; Lip, Gregory Y. H.

doi:10.1161/strokeaha.117.018773

Cited by 125 publications

(117 citation statements)

References 29 publications

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“…Apixaban had the shortest mean following‐up period of only 0.76 years due to its introduction later to the market in Taiwan. Although the follow‐up period of apixaban was limited in our present study, our results were compatible with the latest result of Cha et al, showing that apixaban showed a trend of lower risk of IS (HR, 0.67; 95% CI, 0.35–1.17), a significantly lower risk of intracranial hemorrhage (HR, 0.30; 95% CI, 0.09–0.70) and all‐cause mortality (HR, 0.32; 95% CI, 0.18–0.53) compared to warfarin in Koreans with NVAF 11. Nevertheless, enrollment of more patients and longer follow‐up periods are necessary to demonstrate the efficacy and safety of Asians taking apixaban in the future.…”

Section: Discussionmentioning

confidence: 93%

“…However, the follow‐up periods and patient numbers in those real‐world studies were limited, and the efficacy and safety profiles of apixaban were lacking. As we know, there has been only 1 publication that directly compares the efficacy and safety of all 3 NOACs (ie, apixaban, dabigatran, and rivaroxaban) in a limited number of Asians with AF 11. The objective of this study was to compare the efficacy and safety of apixaban, dabigatran, and rivaroxaban with warfarin in Asians with NVAF as a nationwide retrospective cohort study with an extended follow‐up period.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

Chan

See

et al. 2018

JAHA

116

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BackgroundWhether non–vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin among Asians with nonvalvular atrial fibrillation remains unclear.Methods and ResultsIn this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, there were 5843, 20 079, 27 777, and 19 375 nonvalvular atrial fibrillation patients taking apixaban, dabigatran, rivaroxaban and warfarin, respectively, from June 1, 2012 to December 31, 2016. Propensity‐score weighting was used to balance covariates across study groups. Patients were followed until the first occurrence of any efficacy or safety outcome or the end date of study. Hazard ratios (95% confidence intervals) comparing apixaban, dabigatran, and rivaroxaban with warfarin were: ischemic stroke/systemic embolism (IS/SE), 0.55 (0.43–0.69), 0.82 (0.68–0.98), and 0.81 (0.67–0.97); major bleeding, 0.41 (0.31–0.53), 0.65 (0.53–0.80), and 0.58 (0.46–0.72); and all‐cause mortality, 0.58 (0.51–0.66), 0.61 (0.54–0.68), and 0.57 (0.51–0.65). A total of 3623 (62%), 17 760 (88%), and 26 000 (94%) patients were taking low‐dose apixaban (2.5 mg twice daily), dabigatran (110 mg twice daily), and rivaroxaban (10–15 mg once daily), respectively. Similar to all‐dose NOACs, all low‐dose NOACs had lower risk of IS/SE, major bleeding, and mortality when compared with warfarin. In contrast to other standard‐dose NOACs, apixaban was associated with lower risks of IS/SE (0.45 [0.31–0.65]), major bleeding (0.29 [0.18–0.46]), and mortality (0.23 [0.17–0.31]) than warfarin.ConclusionsAll NOACs were associated with lower risk of IS/SE, major bleeding, and mortality compared with warfarin in the largest real‐world practice among Asians with nonvalvular atrial fibrillation. All low‐dose NOACs had lower risk of IS/SE, major bleeding, and mortality when compared with warfarin. Standard‐dose apixaban caused a lower risk of IS/SE, major bleeding, and mortality compared with warfarin.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

Chan

See

et al. 2018

JAHA

116

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“…Various factors have been shown to affect bleeding events . Studies ranging from observational studies, randomized control trials along with several meta‐analyses have shown that Asians are prone to bleeding more than other racial groups . Poor anticoagulation control and genetic factors have been highlighted as the main reasons.…”

Section: Discussionmentioning

confidence: 99%

“…While there are a large number of published reports evaluating the incidence, risk factors, and outcomes of warfarin‐associated major bleeding (WAMB), almost all of those reports were from the developed countries. Some data on WAMB in Asian population have been published as a subanalysis of large, randomized, controlled trials comparing NOACs versus warfarin or from registries . However, these data were derived only from non‐valvular atrial fibrillation (NAVF) patients while patients using warfarin for other important indications were not included.…”

Section: Introductionmentioning

confidence: 99%

Incidence, risk factors, and outcomes of warfarin‐associated major bleeding in Thai population

Priksri

Rattanavipanon

Saejear

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This study aimed to describe incidence, risk factors, and outcomes of warfarin‐associated major bleeding (WAMB) in Thai patients. Method A nested case‐control study was conducted in a cohort of adult patients receiving ≥6 months of warfarin therapy who were prospectively followed up at a tertiary care hospital in Thailand during January 2011 to December 2014. Logistic regression was used to identify risk factors associated with WAMB. The area under the receiver operating characteristic (AUROC) curve was used to assess the performance of the HAS‐BLED score to predict WAMB in patients with non‐valvular atrial fibrillation (NVAF). Results Among 1604 patients (2972 patient‐year of follow‐up), there were 93 major bleeding that occurred in 76 patients. The incidence of WAMB was 3.13 events per 100 patient‐year. Time in therapeutic range (TTR) of <60% (RR: 3.62, 95% CI: 1.94‐6.73, P < 0.001), mechanical valve replacement at mitral position (RR 3.43, 95% CI: 1.92‐6.16, P < 0.001) cancer (RR: 2.84, 95% CI: 1.11‐7.29, P = 0.029), and age ≥ 65 years (RR: 2.37, 95% CI: 1.20‐4.67, P = 0.012) were independent risk factors for WAMB. There were 17 fatalities and 12 cases of disabilities from WAMB. Mean cost of WAMB was 45 341.54 THB/event. An exploratory analysis suggested that HASBLED score demonstrated an excellent discriminatory capacity to predict WAMB among NVAF patients (AUROC of 0.91, 95% CI: 0.85‐0.97, P < 0.001). Conclusion WAMB in Thai population is common and associated with high rate of morbidity and mortality. Improvement in anticoagulation control is clearly needed.

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“…This raises concerns regarding hemorrhagic events and therapeutic anticoagulative effects. Encouragingly, recent studies have indicated that a reduced dosage (dabigatran 110 mg twice daily or rivaroxaban 10 mg once daily) could have a similar stroke prophylactic effect in the Asian population . Based on the present evidence, we generally prescribe reduced dosages to patients with a relatively high risk of bleeding.…”

Section: Discussionmentioning

confidence: 76%

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

Zhang

Ren

Wang

et al. 2019

Cardiovasc electrophysiol

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Introduction Cryoballoon ablation (CBA) results in satisfactory outcomes for drug‐resistant atrial fibrillation (AF) patients. However, the efficacy and safety of CBA have not yet been tested in the Chinese elderly population. Therefore, this study compared the recurrence of AF and complications of CBA in patients ≥75 years and <75 years. Methods A total of 677 patients (<75 years, n = 550; ≥ 75 years, n = 127) with paroxysmal (n = 603) or persistent (n = 74) non‐valvular drug‐resistant AF were included. The efficacy was assessed by the recurrence of AF, and the safety was evaluated by peri‐ and post‐procedural complications. Results The CHA2DS2‐VASc (2.6 ± 1.7 vs 4.8 ± 1.6, P < .01) and HAS‐BLED (1.8 ± 0.8 vs 2.0 ± 0.8, P = .01) scores were significantly higher in the elderly group. The instant pulmonary vein isolation success rate was comparable (99.11% younger vs 98.98% older, P = .99). After a mean follow‐up time of 12.8 ± 9.6 months, the 1‐year freedom from AF rate was 80.6% vs 85.8% in the older and younger groups, respectively, while the survival analysis showed a nonsignificant difference in the rate of freedom from AF (log‐rank P = .46). Cox regression showed that age was not a predictive factor for AF recurrence and was not dichotomized (hazard ratio [HR] = 0.868, 95% confidence interval [CI] 0.509‐1.481; P = .6046) or continuous (HR = 0.990, 95% CI, 0.968‐1.012, P = .3642). Similar complications rates were observed, including stroke (1.0% younger vs 0.93% older, P = .95) and major hemorrhagic events (1.2% younger vs 0% elder, P = .25). Conclusions The efficacy and safety profiles of CBA in patients older than 75 years are comparable with those in younger patients.

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Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Atrial Fibrillation

Abstract: In real-world practice among a high-risk Asian atrial fibrillation population, all 3 NOACs demonstrated similar risk of ischemic stroke and lower risk of ICH compared with warfarin. All-cause mortality was significantly lower only with dabigatran and apixaban.

Cited by 125 publications

References 29 publications

Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

Incidence, risk factors, and outcomes of warfarin‐associated major bleeding in Thai population

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

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