Ischemic Stroke and Intracranial Hemorrhage With Aspirin, Dabigatran, and Warfarin

Ho, Chiu M.; Ho, Mei-Han; Chan, Pak Hei; Hai, Jo-Jo; Cheung, Emmanuel Hei-Lok; Yeung, Chi K; Lau, Kevin Ka-Lun; Chan, Koon‐Ho; Lau, Chu‐Pak; Lip, Gregory Y.H.; Leung, Gilberto Ka Kit; Tse, Hung‐Fat; Siu, Chung‐Wah

doi:10.1161/strokeaha.114.006476

Cited by 92 publications

(92 citation statements)

References 39 publications

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“…The J‐ROCKET AF trial (Japanese Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) showed that the pharmacokinetic profiles of a 15‐mg dose of rivaroxaban in Japanese patients was similar to the 20‐mg dose in white patients, indicating that low‐dose rivaroxaban with 15/10 mg is adequate for stroke prevention in AF patients 35. Chan et al also reported that low‐dose dabigatran was associated with the lowest risk of ischemic stroke and ICH compared with warfarin with a variety of quality controls in elderly Chinese with AF 36, 37, 38. Further studies are warranted to determine the so‐called “optimal” dose of NOACs in Asians with AF.…”

Section: Discussionmentioning

confidence: 85%

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

Chan

See

et al. 2018

JAHA

124

100

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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: 85%

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

Chan

See

et al. 2018

JAHA

124

100

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“…It is estimated that 10-30% of AF are not diagnosed 32,35 and more than 40% of patients at high risk of stroke fail to receive guideline-recommended oral anticoagulant treatment 11,35 . 39 and increased risk of stroke 40,41 . All these gaps highlight unmet needs for stroke prevention in undiagnosed and undertreated AF, which will shed light on the strategies needed to eliminate disparities in treatment.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Ischemic Stroke on Atrial Fibrillation-Related Healthcare Cost: A Systematic Review

Au-Doung

Chan

2016

Value in Health

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Aim: To summarize healthcare costs incurred by patients with atrial fibrillation (AF) who developed ischemic stroke, explore factors associated with increased cost and highlight the importance of anticoagulation therapy for stroke prophylaxis. Methods:A systematic literature search of PubMed, EMBASE, Web of Science and the health economic evaluation database was conducted up to December 2015. Studies focused on the cost and/or resource utilization of ischemic stroke in patients with AF were included. Reported costs were converted to international dollars (I$) and adjusted to 2015 values. Alongside the narrative review of included studies, Spearman's correlation, independent-samples t-test and one-way ANOVA were used to explore factors associated with cost differences between studies.Results: Sixteen studies published from nine countries were identified. Based on currency conversion rates in 2015, ischemic stroke related healthcare costs were estimated to be I$41,420, I$12,895 and I$8,184 for high-income, upper middle-income and lower middle-income economies respectively. Local GDP per capita accounted for approximately 50% of the healthcare cost variation among countries. Major component of overall cost was from hospitalization. Ischemic stroke incurring in patients with AF ≥75 years were 2.3 times that of their younger peers (p=0.049). Conclusions:The economic burden from ischemic stroke in patients with AF is considerable with positive association to country income. Clinicians and stakeholders should be aware of the importance of anticoagulation therapies in stroke prophylaxis, the occurrence of stroke and the downstream economic burden on an increasingly aging population.Keywords: stroke prophylaxis; atrial fibrillation; anticoagulation therapy; healthcare cost 3 Condensed abstractThis systematic review estimated stroke-related healthcare cost across nine countries, with a positive correlation to country income. The cost for elderly patients' ≥75 years was doubled against their younger peers. Adequate anticoagulation therapy for stroke prophylaxis and the downstream clinical and economic benefits in increasingly aging population are highlighted.4

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“…8 What are the implications of these findings for clinical practice? The results by Ho et al 5 add to the accumulating and now compelling evidence that anticoagulation offers important benefits to East Asian patients with atrial fibrillation. Healthcare providers and patients in Asian countries must take note, and urgently implement readily available and highly effective treatments to reduce the enormous burden of preventable stroke.…”

mentioning

confidence: 87%

“…The data presented by Ho et al 5 alert clinicians and patients to the requirement to evaluate better methods of healthcare delivery, so that highly effective, evidence-based therapies are appropriately implemented. At the same time, there also remains a need for further studies to understand the risk factors better, causes, and consequences of bleeding in patients with atrial fibrillation who are treated with antithrombotic therapy because fear of bleeding remains an important barrier to the appropriate use of anticoagulant therapy in this population.…”

Section: Intensity and Quality Of Warfarin Anticoagulation In Chinesementioning

confidence: 99%

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Intensity and Quality of Warfarin Anticoagulation in Chinese Patients

Eikelboom

Hart

2015

Stroke

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Ischemic Stroke and Intracranial Hemorrhage With Aspirin, Dabigatran, and Warfarin

Cited by 92 publications

References 39 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

The Impact of Ischemic Stroke on Atrial Fibrillation-Related Healthcare Cost: A Systematic Review

Intensity and Quality of Warfarin Anticoagulation in Chinese Patients

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