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Effectiveness and Safety of Four Direct Oral Anticoagulants in Asians with Non-valvular Atrial Fibrillation.

Chest. 2019 May 16;:

Authors: Chan YH, Lee HF, See LC, Tu HT, Chao TF, Yeh YH, Wu LS, Kuo CT, Chang SH, Lip GYH

Abstract
BACKGROUND: Whether four direct oral anticoagulants (DOACs) are superior to warfarin in Asians with nonvalvular atrial fibrillation (NVAF) remains unclear.
METHODS: This nationwide retrospective cohort study is based on data from Taiwan’s National Health Insurance Research Database from June 1, 2012, to December 31, 2017, covering 4,577, 9,952, 33,022, 22,371, and 19,761 NVAF patients taking edoxaban, apixaban, rivaroxaban, dabigatran, and warfarin, respectively. Propensity score weighting was used to balance covariates across study groups. Patients were followed-up until occurrence of study outcomes or end date of study.
RESULTS: Edoxaban, apixaban, and rivaroxaban were associated with lower risk of ischemic stroke/systemic embolism than warfarin. All DOACs had a lower risk of major bleeding than warfarin. Apixaban was associated with a lower risk of major bleeding than rivaroxaban and dabigatran, whereas the risk of major bleeding is comparable between edoxaban and apixaban. The reduced risks of thromboembolism/major bleeding for four DOACs persisted in high risk subgroups including chronic kidney disease, elder patients with ≥75 years old, secondary stroke prevention, or high CHA2DS2-VASc of ≥4. A total of 2,924 (64%), 6,359 (64%), 31,108 (94%), and 19,821 (89%) patients received low-dose edoxaban (15-30mg/day), apixaban (2.5mg/twice daily), rivaroxaban (10-15mg/day), and dabigatran (110mg/twice daily), respectively. Effectiveness/safety outcomes with four low-dose DOACs compared to warfarin were consistent with main analysis.
CONCLUSIONS: In the largest real-world practice study among Asians with NVAF, four DOACs were associated with lower risks of thromboembolism and bleeding than warfarin. There was consistency even amongst high risk subgroups and whether standard dose or low dose regimes were compared.

PMID: 31103697 [PubMed – as supplied by publisher]

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