Suboptimal Anticoagulant Management in Japanese Patients with Nonvalvular Atrial Fibrillation Receiving Warfarin for Stroke Prevention

Abstract

In this EMR-based clinical study, patients who switched to DOACs had both poor or inadequate PT-INR control and higher risk factors of stroke. Many patients receiving warfarin did not achieve sufficient PT-INR therapeutic range. DOACs could be recommended in Japanese patients with NVAF with inadequate PT-INR control and increased risk of stroke.

Two-Year Outcomes of Anticoagulation for Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation ― SAMURAI-NVAF Study ―

“…Similarly, the present patients were more dependent, more frail, more dysphagic, and more cognitively impaired. In addition, maintenance of a prolonged time in the therapeutic range for warfarin over an extended period of years is much more difficult in realworld observational studies than in RCTs, [25][26][27] which might contribute to more fatal events. Patients with dysphagia who needed powder formulations might often be treated using warfarin, because administration of capsule-release dabigatran granules is not recommended for fear of blood level elevation, and crushed factor Xa inhibitor tablets were underused during our study period.…”

Safety and effectiveness of apixaban in Japanese patients with nonvalvular atrial fibrillation in clinical practice: A regulatory postmarketing surveillance, the STANDARD study

“…In our study, poor INR control was the most common reason for switching from warfarin to apixaban, with the risk score of stroke or hemorrhage being higher in patients who switched from warfarin compared with apixaban initiators (Tables and ). Indeed, results from a nationwide database study indicated that Japanese NVAF patients who continued to receive warfarin had both poor or inadequate INR control and higher stroke risk compared with those who switched from warfarin to NOACs …”

“…Indeed, results from a nationwide database study indicated that Japanese NVAF patients who continued to receive warfarin had both poor or inadequate INR control and higher stroke risk compared with those who switched from warfarin to NOACs. 29 Approximately 70% of patients who switched from warfarin to apixaban due to uncontrolled INR started apixaban at an INR value of <2.0 as recommended in the Japanese package insert of apixaban. 22 Importantly, the incidence rate of hemorrhagic events did not increase in patients switching from warfarin to apixaban (…”

The Influence of CYP4F2 Polymorphisms on Warfarin Doses in Korean Patients with a Variety of Diseases

“…19 Studies of Asian patients have chosen this guideline as their target INR. [20][21][22] We also chose this as our target INR.…”