BACKGROUND: Real-world effectiveness and safety of antithrombotics in nonvalvular atrial fibrillation (NVAF) patients in Singapore has not been thoroughly studied. HYPOTHESIS: Users of various antithrombotics experience a significantly different risk of stroke and major bleed compared with warfarin users. METHODS: This multicenter retrospective cohort study included patients age ≥ 21 years newly diagnosed with NVAF between July 2012 and September 2015. Using electronic medical records, data on patients' demographics, antithrombotics prescribed, and CHA2 DS2 -VASc and HAS-BLED risk factors were collected. Patients were followed for 1 year from diagnosis for the primary effectiveness and safety endpoints of incident stroke or systemic embolism and major bleed, respectively. The secondary safety endpoint was overall bleed. Hazard ratios (HR) were determined from Cox regression. RESULTS: Of 743 patients included, 224 were on warfarin, 156 on direct oral anticoagulants (DOACs), 277 on single antiplatelet therapy (SAPT), 28 on dual antiplatelet therapy (DAPT), and 58 on no therapy. Mean age (±SD) was 68.7 ± 13.0 years. Compared with warfarin users, SAPT (adjusted [adj.] HR: 3.70, 95% confidence interval [CI]: 1.21-11.3) and DAPT users (adj. HR: 10.1, 95% CI: 1.51-67.2) were more likely to develop thromboembolic outcomes. Also, DOAC users (adj. HR: 0.304, 95% CI: 0.158-0.585), SAPT users (adj. HR: 0.142, 95% CI: 0.0680-0.295), and DAPT users (adj. HR: 0.112, 95% CI: 0.0146-0.857) were less likely to experience any bleed compared with warfarin users. CONCLUSIONS: SAPT and DAPT are less effective than warfarin in NVAF patients. DOACs may be considered in view of lower risk of overall bleed.
BACKGROUND: Real-world effectiveness and safety of antithrombotics in nonvalvular atrial fibrillation (NVAF) patients in Singapore has not been thoroughly studied. HYPOTHESIS: Users of various antithrombotics experience a significantly different risk of stroke and major bleed compared with warfarin users. METHODS: This multicenter retrospective cohort study included patients age ≥ 21 years newly diagnosed with NVAF between July 2012 and September 2015. Using electronic medical records, data on patients' demographics, antithrombotics prescribed, and CHA2 DS2 -VASc and HAS-BLED risk factors were collected. Patients were followed for 1 year from diagnosis for the primary effectiveness and safety endpoints of incident stroke or systemic embolism and major bleed, respectively. The secondary safety endpoint was overall bleed. Hazard ratios (HR) were determined from Cox regression. RESULTS: Of 743 patients included, 224 were on warfarin, 156 on direct oral anticoagulants (DOACs), 277 on single antiplatelet therapy (SAPT), 28 on dual antiplatelet therapy (DAPT), and 58 on no therapy. Mean age (±SD) was 68.7 ± 13.0 years. Compared with warfarin users, SAPT (adjusted [adj.] HR: 3.70, 95% confidence interval [CI]: 1.21-11.3) and DAPT users (adj. HR: 10.1, 95% CI: 1.51-67.2) were more likely to develop thromboembolic outcomes. Also, DOAC users (adj. HR: 0.304, 95% CI: 0.158-0.585), SAPT users (adj. HR: 0.142, 95% CI: 0.0680-0.295), and DAPT users (adj. HR: 0.112, 95% CI: 0.0146-0.857) were less likely to experience any bleed compared with warfarin users. CONCLUSIONS:SAPT and DAPT are less effective than warfarin in NVAF patients. DOACs may be considered in view of lower risk of overall bleed.
Authors: Gregory Y H Lip; Stephan Windecker; Kurt Huber; Paulus Kirchhof; Francisco Marin; Jurriën M Ten Berg; Karl Georg Haeusler; Giuseppe Boriani; Davide Capodanno; Martine Gilard; Uwe Zeymer; Deirdre Lane; Robert F Storey; Hector Bueno; Jean-Philippe Collet; Laurent Fauchier; Sigrun Halvorsen; Maddalena Lettino; Joao Morais; Christian Mueller; Tatjana S Potpara; Lars Hvilsted Rasmussen; Andrea Rubboli; Juan Tamargo; Marco Valgimigli; Jose L Zamorano Journal: Eur Heart J Date: 2014-08-25 Impact factor: 29.983
Authors: Carl van Walraven; Robert G Hart; Daniel E Singer; Andreas Laupacis; Stuart Connolly; Palle Petersen; Peter J Koudstaal; Yuchiao Chang; Beppie Hellemons Journal: JAMA Date: 2002-11-20 Impact factor: 56.272
Authors: Stuart J Connolly; Truman J Milling; John W Eikelboom; C Michael Gibson; John T Curnutte; Alex Gold; Michele D Bronson; Genmin Lu; Pamela B Conley; Peter Verhamme; Jeannot Schmidt; Saskia Middeldorp; Alexander T Cohen; Jan Beyer-Westendorf; Pierre Albaladejo; Jose Lopez-Sendon; Shelly Goodman; Janet Leeds; Brian L Wiens; Deborah M Siegal; Elena Zotova; Brandi Meeks; Juliet Nakamya; W Ting Lim; Mark Crowther Journal: N Engl J Med Date: 2016-08-30 Impact factor: 91.245