Oral Anticoagulation in Asian Patients With Atrial Fibrillation and a History of Intracranial Hemorrhage
| Autor: | So Ryoung Lee, Eue Keun Choi, Jin Hyung Jung, Kyungdo Han, Seil Oh, Gregory Y.H. Lip, Myung Jin Cha, Soonil Kwon |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Asian Continental Ancestry Group
Male Stroke/etiology medicine.medical_specialty Administration Oral Warfarin/therapeutic use Cohort Studies Recurrence Internal medicine medicine Humans In patient cardiovascular diseases Factor Xa Inhibitors/therapeutic use Stroke Oral anticoagulation Aged Proportional Hazards Models Retrospective Studies Aged 80 and over Advanced and Specialized Nursing business.industry Proportional hazards model Warfarin Retrospective cohort study Atrial fibrillation Middle Aged Brain Ischemia/etiology medicine.disease Treatment Outcome Anticoagulants/therapeutic use Intracranial Hemorrhages/chemically induced Cardiology Female Republic of Korea/epidemiology Neurology (clinical) Cardiology and Cardiovascular Medicine business Atrial Fibrillation/complications Cohort study medicine.drug |
| Zdroj: | Lee, S-R, Choi, E-K, Kwon, S, Jung, J-H, Han, K-D, Cha, M-J, Oh, S & Lip, G Y H 2020, ' Oral Anticoagulation in Asian Patients With Atrial Fibrillation and a History of Intracranial Hemorrhage ', Stroke, vol. 51, no. 2, pp. 416-423 . https://doi.org/10.1161/STROKEAHA.119.028030 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.119.028030 |
| Popis: | Background and Purpose— Warfarin is associated with a better net clinical benefit compared with no treatment in patients with nonvalvular atrial fibrillation (AF) and history of intracranial hemorrhage (ICH). There are limited data on nonvitamin K antagonist oral anticoagulants (NOACs) in these patients, especially in the Asian population. We aimed to compare the effectiveness and safety of NOACs to warfarin in a large-scale nationwide Asian population with AF and a history of ICH. Methods— Using the Korean Health Insurance Review and Assessment database from January 2010 to April 2018, we identified patients with oral anticoagulant naïve nonvalvular AF with a prior spontaneous ICH. For the comparisons, warfarin and NOAC groups were balanced using propensity score weighting. Ischemic stroke, ICH, composite outcome (ischemic stroke+ICH), fatal ischemic stroke, fatal ICH, death from composite outcome, and all-cause death were evaluated as clinical outcomes. Results— Among 5712 patients with AF with prior ICH, 2434 were treated with warfarin and 3278 were treated with NOAC. Baseline characteristics were well-balanced after propensity score weighting (mean age 72.5 years and CHA 2 DS 2 -VASc score 4.0). Compared with warfarin, NOAC was associated with lower risks of ischemic stroke (hazard ratio [HR], 0.77 [95% CI, 0.61–0.97]), ICH (HR, 0.66 [95% CI, 0.47–0.92]), and composite outcome (HR, 0.73 [95% CI, 0.60–0.88]). NOAC was associated with lower risks of fatal stroke (HR, 0.54 [95% CI, 0.32–0.89]), death from composite outcome (HR, 0.53 [95% CI, 0.34–0.81]), and all-cause death (HR, 0.83 [95% CI, 0.69–0.99]) than warfarin. NOAC showed nonsignificant trends toward to reduce fatal ICH compared with warfarin (HR, 0.47 [95% CI, 0.20–1.03]). Conclusions— NOAC was associated with a significant lower risk of ICH and ischemic stroke compared with warfarin. NOAC might be a more effective and safer treatment option for Asian patients with nonvalvular AF and a prior history of ICH. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|