Differences in outcomes between oral anticoagulation "new starters" and "switchers" in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials

Bai, Ying, Shantsila, Alena ORCID: 0000-0002-0594-8576 and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2019) Differences in outcomes between oral anticoagulation "new starters" and "switchers" in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials. JOURNAL OF ARRHYTHMIA, 35 (6). pp. 815-820.

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Official URL: http://dx.doi.org/10.1002/joa3.12255

Abstract

<h4>Background</h4>To explore differences in outcomes between dose-adjusted vitamin K antagonists (VKAs) "new starters" and "switchers" in patients with nonvalvular atrial fibrillation (AF).<h4>Methods</h4>A post hoc analysis was performed to assess the outcome differences between VKA "new starters" and "switchers" in AF patients using pooled individual patient data of AMADEUS and BOREALIS trials.<h4>Results</h4>A total of 4169 AF patients were included in the present analysis, which included 1383 "VKA new starters" and 2786 "VKA switchers". VKA new starters had higher crude rates of all-cause mortality (<i>P</i> = .035) and cardiovascular death (<i>P</i> = .047) compared to switchers. On multivariable Cox regression analysis, both "new starters" and "switchers" showed nonsignificant trends for different risks of stroke/systemic thromboembolism (SE) (hazard ratio (HR): 1.66, 95%CI: 0.95-2.90, <i>P</i> = .08), major bleeding (HR: 1.25, 95% CI: 0.73-2.16, <i>P</i> = .42), and all-cause death (HR: 1.09, 95% CI: 0.75-1.57, <i>P</i> = .65). On Kaplan-Meier analysis, both groups had similar risks of stroke/systemic embolism (<i>P</i> = .09), major bleeding (<i>P</i> = .28), and all-cause death (<i>P</i> = .06).<h4>Conclusions</h4>In this post hoc analysis of clinical trial patients with AF, "new starters" and "switchers" for VKA initiation had nonstatistically significant rates of trial-adjudicated thromboembolism, major bleeding, and all-cause mortality.

Item Type:	Article
Uncontrolled Keywords:	new starter, switcher, vitamin K antagonists
Depositing User:	Symplectic Admin
Date Deposited:	29 Nov 2019 16:50
Last Modified:	19 Jan 2023 00:18
DOI:	10.1002/joa3.12255
Open Access URL:	https://doi.org/10.1002/joa3.12255
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3064084