Myung-Jin Cha1, Eue-Keun Choi2, Kyung-Do Han1, So-Ryoung Lee1, Woo-Hyun Lim1, Seil Oh1, Gregory Y H Lip1. 1. From the Department of Internal Medicine, Seoul National University Hospital, Republic of Korea (M.-J.C., E.-K.C., S.O.); Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (K.-D.H.); Department of Internal Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea (S.-R.L.); Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea (W.-H.L.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Denmark (G.Y.H.L.). 2. From the Department of Internal Medicine, Seoul National University Hospital, Republic of Korea (M.-J.C., E.-K.C., S.O.); Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (K.-D.H.); Department of Internal Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea (S.-R.L.); Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea (W.-H.L.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Denmark (G.Y.H.L.). choiek17@snu.ac.kr.
Abstract
BACKGROUND AND PURPOSE: There are limited real-world data comparing the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asians with nonvalvular atrial fibrillation. We aimed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population, with particular focus on high-risk patients. METHODS: Using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke, intracranial hemorrhage (ICH) events, and all-cause death in NOAC users (n=11 611 total, n=5681 taking rivaroxaban, n=3741 taking dabigatran, and n=2189 taking apixaban) compared with propensity score-matched warfarin users (n=23 222) among patients with high-risk atrial fibrillation (CHA2DS2-VASc score ≥2) between 2014 and 2015. RESULTS: NOAC treatment was associated with similar risk of ischemic stroke and lower risk of ICH and all-cause mortality compared with warfarin. All 3 NOACs were associated with a similar risk of ischemic stroke and a lower risk of ICH compared with warfarin. Dabigatran and apixaban were associated with a lower risk of total mortality and the composite net clinical outcome (ischemic stroke, ICH, and all-cause death) compared with warfarin, whereas this was nonsignificant for rivaroxaban. Among previously oral anticoagulant-naive patients (n=23 262), dabigatran and apixaban were superior to warfarin for ICH prevention, whereas rivaroxaban and warfarin were associated with similar risk of ICH. CONCLUSIONS: 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.
BACKGROUND AND PURPOSE: There are limited real-world data comparing the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asians with nonvalvular atrial fibrillation. We aimed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population, with particular focus on high-risk patients. METHODS: Using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke, intracranial hemorrhage (ICH) events, and all-cause death in NOAC users (n=11 611 total, n=5681 taking rivaroxaban, n=3741 taking dabigatran, and n=2189 taking apixaban) compared with propensity score-matched warfarin users (n=23 222) among patients with high-risk atrial fibrillation (CHA2DS2-VASc score ≥2) between 2014 and 2015. RESULTS:NOAC treatment was associated with similar risk of ischemic stroke and lower risk of ICH and all-cause mortality compared with warfarin. All 3 NOACs were associated with a similar risk of ischemic stroke and a lower risk of ICH compared with warfarin. Dabigatran and apixaban were associated with a lower risk of total mortality and the composite net clinical outcome (ischemic stroke, ICH, and all-cause death) compared with warfarin, whereas this was nonsignificant for rivaroxaban. Among previously oral anticoagulant-naive patients (n=23 262), dabigatran and apixaban were superior to warfarin for ICH prevention, whereas rivaroxaban and warfarin were associated with similar risk of ICH. CONCLUSIONS: 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.
Authors: Zian H Tseng; Satvik Ramakrishna; James W Salazar; Eric Vittinghoff; Jeffrey E Olgin; Ellen Moffatt Journal: Circ Arrhythm Electrophysiol Date: 2021-04-09