NOACs demonstrated a positive net clinical benefit (NNTnet 101 vs no OAC; 27 vs warfarin), whereas overall warfarin use had a negative net benefit (NNTnet -37) unless TTR was ≥65%.
Observational (n=3,405)
Yes
Do NOACs or warfarin improve net clinical benefit compared to no oral anticoagulation in Asian patients with non-valvular atrial fibrillation?
NOACs and well-controlled warfarin (TTR ≥65%) provide a positive net clinical benefit in Asian patients with atrial fibrillation, whereas overall warfarin use without adequate control results in net harm.
Background: Oral anticoagulants (OAC) can reduce ischemic stroke/systemic embolism (SSE) in patients with non-valvular atrial fibrillation (AF) while increasing the risk of major bleeding. We aimed to analyze the number needed to treat for the net benefit (NNTnet) of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs). Methods: We analyzed the results from multicenter national AF registry from 27 hospitals in Thailand. Follow-up data were collected every 6 months until 3 years. Main outcomes were SSE, major bleeding, and intracranial hemorrhage (ICH). NNT was calculated from the absolute risk reduction (ARR) of SSE or absolute risk increase (ARI) of major bleeding or ICH. We compared NNTnet of warfarin versus no OAC, NOACs versus no OAC, and NOACs versus warfarin. Warfarin was also categorized into time in therapeutic range (TTR) < and ≥65%. Results: We studied a total of 3405 patients (mean age 67.8 ± 11.3 years, 1424 (41.8%) were female). The incidence rates of SSE, major bleeding, and ICH were 1.51, 2.25, and 0.78 per 100 person-years, respectively. Warfarin had negative NNTnet -37 compared to no OAC. NOACs had positive NNTnet 101 and 27 compared to no OACs and warfarin. Warfarin with TTR 65% had positive NNTnet 42 compared to no OAC. NOACs had comparable NNTnet as warfarin with TTR ≥65%. Conclusion: Warfarin had a negative NNTnet compared to no OAC. Only warfarin with TTR 65% has positive NNTnet. NOACs had positive NNTnet compared to no OAC and when compared to warfarin.
Krittayaphong et al. (Sat,) conducted a observational in non-valvular atrial fibrillation (n=3,405). Oral anticoagulants (NOACs and warfarin) vs. No oral anticoagulant was evaluated on Number needed to treat for the net benefit (NNTnet) based on ischemic stroke/systemic embolism, major bleeding, and intracranial hemorrhage. NOACs demonstrated a positive net clinical benefit (NNTnet 101 vs no OAC; 27 vs warfarin), whereas overall warfarin use had a negative net benefit (NNTnet -37) unless TTR was ≥65%.