Key result
NOACs linked to ~35% lower mortality and fewer thromboembolic events vs warfarin in Asian NVAF.
Why the study?
Limited data regarding efficacy, safety, and optimal dose of NOACs in Asian patients with non-valvular atrial fibrillation was available.
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce mortality, thromboembolic events, and major bleeding compared to warfarin in Asian patients with non-valvular atrial fibrillation?
Cohort (n=62,412)
Yes
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce mortality, thromboembolic events, and major bleeding compared to warfarin in Asian patients with non-valvular atrial fibrillation?
In Asian patients with non-valvular atrial fibrillation, NOACs were associated with lower mortality and thromboembolic events compared to warfarin, with standard-dose NOACs showing more prominent efficacy.
Answers are grounded in this paper and cite their sources.
May support standard-dose NOAC preference over low-dose or warfarin in high-risk Asian NVAF; leaves open optimal dosing without RCTs.
Background: Limited data regarding efficacy, safety, and optimal dose of non-vitamin K antagonist oral anticoagulants (NOAC) in Asian patients with non-valvular atrial fibrillation (NVAF) is available. Purpose: Comparing thromboembolic, bleeding, and mortality outcomes between standard- and low-dose NOACs and warfarin in Asian population with NVAF. Methods: The Korean National Health Insurance Service database included 62,412 NVAF patients with high thromboembolic risk (CHA2DS2-VASc score ≥2) and using oral anticoagulants, between July 2015 and December 2016. The main study outcomes were mortality, thromboembolic events (ischemic stroke and systemic embolism composites), and major bleeding. Results: The patients received the following regular anticoagulation therapies: warfarin (n=11,949, 19.1%), dabigatran (n=13,484; 21.6%), rivaroxaban (n=23,369; 37.4%), and apixaban (n=13,610; 21.9%). Low-dose NOAC (75.2% dabigatran; 59.6% rivaroxaban; 63.3% apixaban) was more frequently used than standard dose. During a median follow-up period of 14.2 months, NOAC treatment was associated with lower mortality rates (HR 0.65, 95% CI 0.61–0.70) and thromboembolic events (HR 0.75, 95% CI 0.67–0.83) compared with warfarin. This better efficacy was more prominent with standard-dose NOAC (mortality, HR 0.49, 95% CI 0.45–0.53; thromboembolic events, HR 0.63, 95% CI 0.55–0.72) than with low-dose NOAC (mortality, HR 0.74, 95% CI 0.69–0.79; thromboembolic events, HR 0.81, 0.72–0.90). In terms of safety, major bleeding risk was lower with dabigatran (HR 0.84, 95% CI 0.72–0.98) and apixaban (HR 0.69, 95% CI0.59–0.81) than with warfarin, whereas that for rivaroxaban was comparable (HR 0.98, 95% CI 0.86–1.12). The efficacy of apixaban was attenuated when low-dose was used in patients ≤75 years without chronic kidney disease (mortality, HR 0.82, 95% CI0.65–1.05; thromboembolic events, HR 0.99, 95% CI 0.77–1.28).
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Cho et al. (2018) conducted a cohort in Non-valvular atrial fibrillation (NVAF) (n=62,412). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Warfarin was evaluated on Mortality (HR 0.65, 95% CI 0.61-0.70). NOAC treatment was associated with lower mortality and thromboembolic events compared with warfarin in Asian patients with NVAF.
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