Stroke prevention using dabigatran in elderly Chinese patients with atrial fibrillation

Chan, Pak Hei; Huang, Duo; Hai, Jo Jo; Li, Wenhua; Yin, Long; Chan, Esther Wai Yin; Wong, Ian C. K.; Lau, Chu‐Pak; Chiang, Chern‐En; Zhu, Jun; Tse, Hung‐Fat; Siu, Chung‐Wah

doi:10.1016/j.hrthm.2015.09.015

Cited by 32 publications

(34 citation statements)

References 36 publications

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“…The J‐ROCKET AF trial (Japanese Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) showed that the pharmacokinetic profiles of a 15‐mg dose of rivaroxaban in Japanese patients was similar to the 20‐mg dose in white patients, indicating that low‐dose rivaroxaban with 15/10 mg is adequate for stroke prevention in AF patients 35. Chan et al also reported that low‐dose dabigatran was associated with the lowest risk of ischemic stroke and ICH compared with warfarin with a variety of quality controls in elderly Chinese with AF 36, 37, 38. Further studies are warranted to determine the so‐called “optimal” dose of NOACs in Asians with AF.…”

Section: Discussionmentioning

confidence: 95%

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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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Section: Discussionmentioning

confidence: 95%

“…35 Chan et al also reported that low-dose dabigatran was associated with the lowest risk of ischemic stroke and ICH compared with warfarin with a variety of quality controls in elderly Chinese with AF. [36][37][38] Further studies are warranted to determine the so-called "optimal" dose of NOACs in Asians with AF.…”

Section: Discussionmentioning

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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“…lf VKA therapy is being considered, the SAMe-TT 2 R 2 score can be used to identify patients who are good candidates for this approach. be considerations in choosing an agent (Table 6) 124,127,128,[134][135][136]174,181,183,[192][193][194][195][196][197][198][199][200][201] for comparative information. The VKAs are still widely used and are an acceptable alternative with target TTR $ 70%.…”

Section: Practical Patient Management Algorithmmentioning

confidence: 99%

Antithrombotic Therapy for Atrial Fibrillation

Lip

Banerjee

Boriani

et al. 2018

Chest

772

328

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“…In addition to trials, several observational studies have investigated the effectiveness and safety of NOACs in clinical use among non-valvular AF patients 8 – 10 , but to our knowledge, the real-world data for rivaroxaban, with a specific focus on different dosages, are sparse. This issue is particularly important because Asians have several demographic characteristics that differ from other ethnic groups.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Different Rivaroxaban Dosage Regimens in Patients with Non-Valvular Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

Huang

Lin

Cheng

et al. 2018

Sci Rep

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The objective of this study is to evaluate the effectiveness of different rivaroxaban dosage regimens in preventing ischemic stroke and systemic thromboembolism among Asians. A retrospective cohort study was conducted on data from nationwide insurance claims in Taiwan. Patients with non-valvular atrial fibrillation under warfarin or rivaroxaban therapy were included. Propensity score matching was used to balance the covariates, and Cox-proportional hazard models were applied to compare the effectiveness and safety of each treatment group. Rivaroxaban was associated with a significantly lower risk of venous thromboembolism (hazard ratio [HR]: 0.51; 95% confidence interval [CI]: 0.29–0.92, P = 0.02) and intracranial hemorrhage (HR: 0.48; 95% CI: 0.32–0.72, P < 0.001) than warfarin. Rivaroxaban 20 mg and 15 mg were associated with a significantly lower risk of ischemic stroke (20 mg, HR: 0.48; CI: 0.29–0.80, P = 0.005; 15 mg, HR: 0.69; CI: 0.53–0.90, P = 0.005), but rivaroxaban 10 mg was not. In the subgroup analysis of patients older than 65 years, the results were generally the same, except that rivaroxaban had a significantly lower risk of ischemic stroke than warfarin.

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Stroke prevention using dabigatran in elderly Chinese patients with atrial fibrillation

Cited by 32 publications

References 36 publications

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

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

Antithrombotic Therapy for Atrial Fibrillation

Effectiveness and Safety of Different Rivaroxaban Dosage Regimens in Patients with Non-Valvular Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

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