Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation



Park, Jiesuck, Lee, So-Ryoung, Choi, Eue-Keun, Kwon, Soonil, Jung, Jin-Hyung, Do-Han, Kyung, Cha, Myung-Jin, Ko, Sang-Bae, Oh, Seil and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2019) Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation. JOURNAL OF CLINICAL MEDICINE, 8 (12). E2228-.

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Abstract

We investigated the effectiveness and safety of direct oral anticoagulants (DOACs) for secondary prevention in patients with atrial fibrillation (AF), particularly focusing on subgroups of patients with severe, disabling, and recent stroke. Using the Korean National Health Insurance Service claims database between January 2010 and April 2018, we selected OAC-naïve patients with non-valvular AF and a history of stroke. Cumulative risks for recurrent stroke, major bleeding, composite outcome (recurrent stroke + major bleeding), and mortality were compared between DOAC and warfarin groups. Among 61,568 patients, 28,839 and 32,729 received warfarin and DOACs, respectively. Compared with warfarin, DOACs were associated with lower risks of recurrent stroke (hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.62-0.72), major bleeding (HR 0.73, 95% CI 0.66-0.80), composite outcome (HR 0.69, 95% CI 0.65-0.73), and mortality. DOAC use resulted in a consistent trend of improved outcomes in the subgroups of patients with severe, disabling, and recent stroke. In conclusion, DOACs were associated with lower risks of recurrent stroke, major bleeding, composite clinical outcomes, and mortality in patients with AF and a history of stroke. These results were consistent across all types of DOACs and subgroups of patients with severe, disabling, and recent stroke.

Item Type: Article
Uncontrolled Keywords: atrial fibrillation, anticoagulants, stroke, secondary prevention
Depositing User: Symplectic Admin
Date Deposited: 12 Feb 2020 13:49
Last Modified: 19 Jan 2023 00:03
DOI: 10.3390/jcm8122228
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3074693