Oral Anticoagulation in Japanese Patients With Atrial Fibrillation

Renewed interest has arisen about the medical and economic burden of AF in Asians. Senoo et al have been concerned about the efficacy and safety of NOACs in this subgroup of 4 There are demonstrated racial differences in the background incidence and types stroke related to AF. It is well known that AF differs considerably between Asian and non-Asian countries, in terms of epidemiology, clinical profile, and optimal anticoagulation levels (Figure In fact, there is the perception in Japan that cardiovascular events rates are lower and bleeding complications are more frequent than in Western populations. 5 However, the risk of stroke and systemic embolism for AF patients taking warfarin appears to be higher in Asians than non-Asians. On the other hand, antico-trial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is an independent risk factor for ischemic stroke. 1 Vitamin K antagonists are highly effective for the prevention of stroke, 2 mainly of ischemic origin, in patients with AF but they have significant limitations. The main pitfall described is the unpredictable anticoagulant response showed by this therapeutic family. Over the last years, non-vitamin K antagonist oral anticoagulants (NOACs), including direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), have been developed. 3 They have rapid, predictable pharmacokinetics and pharmacodynamics, and minimal food or drug interactions with an easier therapeutic strategy. NOACs have been compared with warfarin and demonstrated that they are at least non-inferior for the prevention of stroke or systemic embolism (some of them even superior to warfarin) and safer in terms of reduction of intracranial bleeding