May 14, 2019Stroke
Non–Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Supranormal Renal Function
Why the study?
Clinical trials reported reduced efficacy of NOACs for stroke prevention compared with warfarin in patients with nonvalvular AF and CrCl >95 mL/min.
Do NOACs reduce ischemic stroke and composite clinical outcomes compared to warfarin in Asian patients with nonvalvular atrial fibrillation and supranormal renal function?
Population
Asian patients with nonvalvular AF and CrCl >80 mL/min
Comparison
NOACs (rivaroxaban, dabigatran, apixaban, edoxaban) vs warfarin
Design
Retrospective propensity score-weighted cohort study
Authors
Discussion
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Member takes
Implication
NOACs were associated with better effectiveness/safety than warfarin in Asian AF with CrCl >95; leaves open need for confirmatory RCTs before practice change.
Structured PICO
Do NOACs reduce ischemic stroke and composite clinical outcomes compared to warfarin in Asian patients with nonvalvular atrial fibrillation and supranormal renal function?
P
Population
25,004 Asian patients with nonvalvular atrial fibrillation and supranormal renal function (CrCl >80 mL/min), mean age 66, 63% men, mean CHA2DS2-VASc score 3.0. Data from the Korean National Health Insurance Service database.
I
Intervention
Non-vitamin K antagonist oral anticoagulants (NOACs) including rivaroxaban, dabigatran, apixaban, and edoxaban
C
Comparator
Warfarin
O
Outcome
Composite outcome defined as ischemic stroke + intracranial hemorrhage + gastrointestinal bleeding + all-cause deathcomposite
In Asian patients with nonvalvular atrial fibrillation and supranormal renal function, NOACs demonstrated better effectiveness and safety than warfarin, challenging concerns of reduced efficacy in this subgroup.
Cite This Study
Lee et al. (2019) studied this question.