Racial/Ethnic Differences in the Risk of Intracranial Hemorrhage Among Patients With Atrial Fibrillation

Shen, Albert Yuh-Jer; Yao, Janis F.; Brar, Somjot; Jorgensen, Michael B.; Chen, Wansu

doi:10.1016/j.jacc.2007.01.098

Cited by 584 publications

(460 citation statements)

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“…65 Differences in the propensity for bleeding between East Asian and white populations have also been described. [10][11][12] In an analysis of individuals from the USA with atrial fibrillation, Asian patients were at greater risk of w arfarinassociated intracranial haemor rhage than white individuals, despite similar inter national normalized ratios between the two groups. 11 In contrast to the risk of ischaemic events after PCI, the risk of serious bleeding in East Asian individuals seems to be greater than in white individuals.…”

Section: Consensus Statementsmentioning

confidence: 99%

“…[10][11][12] In an analysis of individuals from the USA with atrial fibrillation, Asian patients were at greater risk of w arfarinassociated intracranial haemor rhage than white individuals, despite similar inter national normalized ratios between the two groups. 11 In contrast to the risk of ischaemic events after PCI, the risk of serious bleeding in East Asian individuals seems to be greater than in white individuals. In a study of Japanese patients undergoing elective implantation of a drug-eluting stent and treated with aspirin plus a thienopyridine (200 mg daily of ticlopidine or 75 mg daily of clopidogrel), a notable 6.5% incidence of major bleeding was observed during the 16 months of DAPT.…”

Section: Consensus Statementsmentioning

confidence: 99%

“…9 Although East Asian ethnic groups are among the most populous (more than 1.5 billion people), very few East Asian patients have been included in the trials to assess the use of P2Y 12 inhibitors, particularly the newer agents prasugrel and ticagrelor. Recognizing concerns about an increased incidence of haemorrhagic stroke and potential bleeding that might occur among East Asian patients receiving antithrombotic therapy, 10,11 even in the absence of hypertension, 12 the World Heart Federation has undertaken an evidence-based review and produced this expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients. This consensus statement (members of the expert panel are listed in Box 1) provides observations and recommendations addressing the regional clinical practice trends in East Asia and highlights the need for future research.…”

Section: Introductionmentioning

confidence: 99%

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World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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| Guideline recommendations on the use of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention (PCI) have been formulated by both the ACC/AHA and the ESC. These recommendations are based primarily on large, phase III, randomized, controlled trials of the P2Y 12 inhibitors clopidogrel, prasugrel, and ticagrelor. However, few East Asian patients have been included in the trials to assess the use of these agents, particularly the newer agents prasugrel and ticagrelor. Additionally, an increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with white patients, and that a different 'therapeutic window' of on-treatment platelet reactivity might be appropriate in East Asian patients. Furthermore, a phenomenon referred to as the 'East Asian paradox' has been described, in which East Asian patients have a similar or even a lower rate of ischaemic events after PCI compared with white patients, despite a higher level of platelet reactivity during DAPT. Recognizing these concerns, the World Heart Federation has undertaken this evidence-based review and produced this expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients.

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Section: Consensus Statementsmentioning

confidence: 99%

Section: Consensus Statementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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“…The safety profiles showed that all NOACs caused a lower risk of intracranial hemorrhage, but an increased risk of gastrointestinal bleeding with rivaroxaban, edoxaban, and dabigatran (150 mg twice daily) compared with warfarin. Of particular note, Asians may receive greater benefit from NOACs compared with non‐Asians, as they carry a higher risk of intracranial hemorrhage and have a greater difficulty maintaining the therapeutic range of international normalized ratio of 2 to 3 when taking warfarin 6, 7. The subgroup analyses from 4 pivotal NOAC trials indicated that NOACs may be more effective and safer in Asians than in non‐Asians 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

Chan

See

et al. 2018

JAHA

126

100

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BackgroundWhether non–vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin among Asians with nonvalvular atrial fibrillation remains unclear.Methods and ResultsIn this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, there were 5843, 20 079, 27 777, and 19 375 nonvalvular atrial fibrillation patients taking apixaban, dabigatran, rivaroxaban and warfarin, respectively, from June 1, 2012 to December 31, 2016. Propensity‐score weighting was used to balance covariates across study groups. Patients were followed until the first occurrence of any efficacy or safety outcome or the end date of study. Hazard ratios (95% confidence intervals) comparing apixaban, dabigatran, and rivaroxaban with warfarin were: ischemic stroke/systemic embolism (IS/SE), 0.55 (0.43–0.69), 0.82 (0.68–0.98), and 0.81 (0.67–0.97); major bleeding, 0.41 (0.31–0.53), 0.65 (0.53–0.80), and 0.58 (0.46–0.72); and all‐cause mortality, 0.58 (0.51–0.66), 0.61 (0.54–0.68), and 0.57 (0.51–0.65). A total of 3623 (62%), 17 760 (88%), and 26 000 (94%) patients were taking low‐dose apixaban (2.5 mg twice daily), dabigatran (110 mg twice daily), and rivaroxaban (10–15 mg once daily), respectively. Similar to all‐dose NOACs, all low‐dose NOACs had lower risk of IS/SE, major bleeding, and mortality when compared with warfarin. In contrast to other standard‐dose NOACs, apixaban was associated with lower risks of IS/SE (0.45 [0.31–0.65]), major bleeding (0.29 [0.18–0.46]), and mortality (0.23 [0.17–0.31]) than warfarin.ConclusionsAll NOACs were associated with lower risk of IS/SE, major bleeding, and mortality compared with warfarin in the largest real‐world practice among Asians with nonvalvular atrial fibrillation. All low‐dose NOACs had lower risk of IS/SE, major bleeding, and mortality when compared with warfarin. Standard‐dose apixaban caused a lower risk of IS/SE, major bleeding, and mortality compared with warfarin.

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“…The risk of ICH with anticoagulation may also depend on an individual's race. Asians have a 6 times higher risk on warfarin compared to whites and are twice as likely to have an ICH when compared to blacks and Hispanics [15].…”

Section: Ich Geneticsmentioning

confidence: 98%

Treatment Targets in Intracerebral Hemorrhage

Sangha

Gonzales

2011

Neurotherapeutics

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Intracerebral hemorrhage (ICH) imparts a higher mortality and morbidity than ischemic stroke. The therapeutic interventions that are currently available focus mainly on supportive care and secondary prevention. There is a paucity of evidence to support any one acute intervention that improves functional outcome. This chapter highlights current treatment targets for ICH based on the pathophysiology of the disease.

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Racial/Ethnic Differences in the Risk of Intracranial Hemorrhage Among Patients With Atrial Fibrillation

Abstract: Nonwhites with AF were at greater risk for warfarin-related ICH. Blacks, Hispanics, and Asians were at successively greater ICH risk than whites.

Cited by 584 publications

References 42 publications

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

Efficacy and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Asians With Nonvalvular Atrial Fibrillation

Treatment Targets in Intracerebral Hemorrhage

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