Oral anticoagulants for Asian patients with atrial fibrillation

Sabir, Ian N.; Khavandi, Kaivan; Brownrigg, Jack; Camm, A. John

doi:10.1038/nrcardio.2014.22

Cited by 37 publications

(41 citation statements)

References 143 publications

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“…However, there is insufficient evidence to support the clinical utility of genetic testing prior to warfarin initiation [58]. Non-vitamin K antagonists have been proposed as a potentially safer option for anticoagulation in Asians [59], but more research is needed to determine the risks and benefits of these newer medications. 2.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Baehr

Peña

2015

J. Racial and Ethnic Health Disparities

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The 2014 National Action Plan for Adverse Drug Event Prevention has recognized adverse drug events (ADEs) as a national priority in order to facilitate a nationwide reduction in patient harms from these events. Throughout this effort, it will be integral to identify populations that may be at particular risk in order to improve care for these patients. We have undertaken a systematic review to evaluate the evidence regarding racial or ethnic disparities in ADEs with particular emphasis on anticoagulants, diabetes agents, and opioids due to the clinical significance and preventability of ADEs associated with these medication classes. From an initial search yielding 3302 studies, we identified 40 eligible studies. Twenty-seven of these included studies demonstrated the presence of a racial or ethnic disparity. There was no consistent evidence for racial or ethnic disparities in the eight studies of ADEs in general. Asians were most frequently determined to be at higher risk of anticoagulant-related ADEs, and black patients were most frequently determined to be at higher risk for diabetes agents-related ADEs. Whites were most frequently identified as at increased risk for opioid-related ADEs. However, few of these studies were specifically designed to evaluate racial or ethnic disparities, lacking a standardized approach to racial/ethnic categorization as well as control for potential confounders. We suggest the need for targeted interventions to reduce ADEs in populations that may be at increased risk, and we suggest strategies for future research.

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Baehr

Peña

2015

J. Racial and Ethnic Health Disparities

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“…1 Moreover, antiplatelet agents have been commonly used (56%) for stroke prevention among Chinese patients with AF, 18 but this approach using antiplatelet agents is neither safe nor effective for stroke prevention in patients with AF. 19 Data on OAC use in developed countries are available from many previous studies. For example, the US nationwide ORBIT-AF study showed that 76% of AF outpatients received OAC (71% warfarin and 5% dabigatran), and the use of OAC was even higher (80%) among those with CHADS₂ scores ≥ 2.…”

Section: Discussionmentioning

confidence: 99%

Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation

Chang¹,

Dong²,

Ma³

et al. 2016

Stroke

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A trial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide. In 2008, the estimated agestandardized AF prevalence in China was 0.65%, suggesting that at least 4 million adults had AF, 1 and it was predicted that 5.2 million men and 3.1 million women aged >60 years will be affected by AF in China by 2050. 2AF increases the risk of stroke, and AF-related stroke is more fatal and disabling, compared with non-AF stroke.3 Oral anticoagulation (OAC) is recommended to reduce the risk of thromboembolic events in patients with AF with either a moderate or high risk of stroke. 4,5 Various registry studies report that nearly half to four fifths of high-risk AF patients were taking OAC therapy in developed countries 6-10 ; however, in Chinese patients with AF, OAC remains underused. 11During the past decade, the Chinese medical societies have made great efforts to improve stroke prevention among Background and Purpose-Reported rates of oral anticoagulation (OAC) use have been low among Chinese patients with atrial fibrillation (AF). With improved awareness, changing guidelines, this situation may be changing over time. We aimed to explore the current status and time trends of OAC use in Beijing. Methods-We used the data set from the Chinese Atrial Fibrillation Registry (CAFR), a prospective, multicenter, hospitalbased registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing. A total of 11 496 patients with AF were enrolled from 2011 to 2014. Results-Seven thousand nine hundred seventy-seven eligible patients were included in this ancillary study.

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“…Asian patients are more sensitive to the anticoagulant effects of warfarin and have higher rates of bleeding when they are in the therapeutic range (12). Therefore, frequent therapeutic monitoring and concern about bleeding events remains an important barrier to the appropriate use of anticoagulant therapy in the Chinese population (25,26). The cost of routine dabigatran or rivaroxaban anticoagulation is too high to be affordable for ordinary patients.…”

Section: Discussionmentioning

confidence: 99%

Use of dabigatran vs. warfarin with low-molecular-weight heparin bridging in catheter ablation for atrial fibrillation patients with a low CHADS2 score

Rong

Xie

et al. 2017

Biomedical Reports

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Abstract. The purpose of the present study was to compare the efficacy and safety of dabigatran and interrupted warfarin with low-molecular-weight heparin bridging in non-valvular atrial fibrillation (AF) catheter ablation. Previously, there has been concerns that bridging therapy increases bleeding events without the benefit of stroke prevention. It has been suggested that bridging therapy should be considered only for patients at high-risk of thrombosis. Nevertheless, bridging therapy in AF patients with a low CHADS2 score may be safe and effective. The authors performed a prospective, observational study that included consecutive 240 patients undergoing AF ablation in P.R. China. A total of 139 patients received 110 mg dabigatran twice daily and 101 patients took dose-adjusted warfarin that had been bridged with low-molecular-weight heparin. The mean patient age was 55.48 years with 72.1% being men and 74.2% having paroxysmal AF. One thromboembolic complication occurred in the dabigatran group compared to none in the warfarin group. Both the groups presented a similar major bleeding rate, total bleeding rate, and bleeding and thromboembolic complications. In patients undergoing AF ablation, the risk of bleeding or thromboembolic complications was similar for both dabigatran and interrupted warfarin with bridging therapy. Bridging therapy appeared to be safe and effective for the low-risk population.

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Oral anticoagulants for Asian patients with atrial fibrillation

Cited by 37 publications

References 143 publications

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation

Use of dabigatran vs. warfarin with low-molecular-weight heparin bridging in catheter ablation for atrial fibrillation patients with a low CHADS2 score

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