Liu, Shin-Huei, Chao, Tze-Fan 
ORCID: 0000-0002-7461-2793, Chan, Yi-Hsin, Liao, Jo-Nan ORCID: 0000-0001-8033-127X, Chen, Tzeng-Ji ORCID: 0000-0002-8350-0232, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Chen, Shih-Ann ORCID: 0000-0002-6674-5625
(2023)
Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients without previous oral anticoagulants or stable under warfarin: a nationwide cohort study.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 25 (5).
euad120-.
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Abstract
<h4>Aims</h4>Investigations on non-VKA oral anticoagulants (NOACs) for atrial fibrillation (AF) patients without taking any oral anticoagulants (OACs) or staying well on warfarin were limited. We aimed to investigate the associations between stroke prevention strategies and clinical outcomes among AF patients who were previously well without taking any OACs or stayed well on warfarin for years.<h4>Methods and results</h4>The retrospective analysis included a total of 54 803 AF patients who did not experience an ischaemic stroke or intra-cranial haemorrhage (ICH) for years after AF was diagnosed. Among these patients, 32 917 patients who did not receive OACs were defined as the 'original non-OAC cohort' (group 1), and 8007 patients who continuously received warfarin were defined as the 'original warfarin cohort' (group 2). In group 1, compared to non-OAC, warfarin showed no significant difference in ischaemic stroke (aHR 0.979, 95%CI 0.863-1.110, P = 0.137) while those initiated NOACs were associated with lower risk (aHR 0.867, 95%CI 0.786-0.956, P = 0.043). When compared to warfarin, the composite of 'ischaemic stroke or ICH' and 'ischaemic stroke or major bleeding' was significantly lower in the NOAC initiator with an aHR of 0.927 (95%CI 0.865-0.994; P = 0.042) and 0.912 (95%CI 0.837-0.994; P < 0.001), respectively. In group 2, when compared to warfarin, those shifted to NOACs were associated with a lower risk of ischaemic stroke (aHR 0.886, 95%CI 0.790-0.993, P = 0.002) and major bleeding (aHR 0.849, 95%CI 0.756-0.953, P < 0.001).<h4>Conclusions</h4>The NOACs should be considered for AF patients who were previously well without taking OACs and those who were free of ischaemic stroke and ICH under warfarin for years.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Atrial fibrillation, Drug initiation, Drug shift, NOACs, Warfarin |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 17 Oct 2023 13:33 |
| Last Modified: | 17 Oct 2023 13:33 |
| DOI: | 10.1093/europace/euad120 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173818 |
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