Effectiveness and Safety of NOACs in Asian Patients With Atrial Fibrillation

Study Questions:

What is the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in Asians with nonvalvular atrial fibrillation (AF)?

Methods:

Using the Korean National Health Insurance Service database, the authors analyzed the risk of ischemic stroke, intracranial hemorrhage (ICH), and all-cause death in NOAC users (n = 11,611) versus propensity-matched warfarin users (n = 23,222) with nonvalvular AF and CHA2DS2-VASc score ≥2 between 2014 and 2015.

Results:

NOAC treatment was associated with similar risks of ischemic stroke and lower risk of ICH and all-cause mortality as compared to warfarin. As compared to warfarin, relative risks of ischemic stroke and ICH were similar for rivaroxaban, dabigatran, and apixaban. Dabigatran and apixaban were associated with a lower risk of mortality and a net clinical benefit (ischemic stroke, ICH, and all-cause death) as compared to warfarin. These risks were similar for rivaroxaban and warfarin.

Conclusions:

The authors concluded that among a high-risk Asian AF population, all three NOACs demonstrated similar risks of ischemic stroke and lower risks of ICH as compared to warfarin. All-cause mortality was significantly lower for dabigatran and apixaban as compared to warfarin.

Perspective:

The results of this nationwide cohort study largely mirror those of the randomized trials. Clinicians can be reassured that Asian patients with AF will experience similar risk reduction with each of the NOAC medications, as was demonstrated in the large randomized clinical trials. In general, NOAC medications are as effective and safer than warfarin with an overall improvement in mortality among AF patients.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Intracranial Hemorrhages, Ischemia, Risk, Risk Reduction Behavior, Secondary Prevention, Stroke, Vascular Diseases, Warfarin


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