Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Studyopen access
- Authors
- Han, Sola; Kim, Young-Hoon; Lee, Myung-Yong; Bang, Oh Young; Jang, Sung-Won; Han, Seongwook; Park, Yoo-Jung; Kang, Seongsik; On, Young Keun; Suh, Hae Sun
- Issue Date
- Sep-2021
- Publisher
- MDPI
- Keywords
- anticoagulants; atrial fibrillation; NOAC; stroke; systemic embolism; warfarin
- Citation
- JOURNAL OF CLINICAL MEDICINE, v.10, no.17
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF CLINICAL MEDICINE
- Volume
- 10
- Number
- 17
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/144654
- DOI
- 10.3390/jcm10173918
- ISSN
- 2077-0383
- Abstract
- Reduced-dose nonvitamin K antagonist oral anticoagulants (NOACs) are commonly prescribed to Asian patients with nonvalvular atrial fibrillation (NVAF). We aimed to compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) between patients treated with reduced-dose NOACs and those treated with warfarin, using the claims database in Korea. Patients with NVAF newly initiated on oral anticoagulants (OACs; apixaban, dabigatran, rivaroxaban, and warfarin) between 1 July 2015 and 30 November 2016 were included. Among all patients with NVAF treated with OACs, 5249, 6033, 7602, and 8648 patients were treated with reduced-dose apixaban, dabigatran, rivaroxaban, and warfarin, respectively. Patients treated with reduced-dose NOACs were older and had higher CHA(2)DS(2)-VASc and HAS-BLED scores than those treated with warfarin. Compared to warfarin, all reduced-dose NOACs showed significantly lower risk of S/SE (hazard ratios (95% confidence interval), 0.63 (0.52-0.75) for apixaban; 0.51 (0.42-0.61) for dabigatran; and 0.67 (0.57-0.79) for rivaroxaban) and MB (0.54 (0.45-0.65) for apixaban; 0.58 (0.49-0.69) for dabigatran; 0.73 (0.63-0.85) for rivaroxaban). In the real-world practice among Asians with NVAF, all reduced-dose NOACs were associated with a significantly lower risk of S/SE and MB compared to those of warfarin.
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