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Article: Comparative Outcomes Between Direct Oral Anticoagulants, Warfarin, and Antiplatelet Monotherapy Among Chinese Patients with Atrial Fibrillation: A Population-Based Cohort Study

TitleComparative Outcomes Between Direct Oral Anticoagulants, Warfarin, and Antiplatelet Monotherapy Among Chinese Patients with Atrial Fibrillation: A Population-Based Cohort Study
Authors
KeywordsAtrial Fibrillation
Anticoagulant Agent
Warfarin
Issue Date2020
PublisherSpringer, co-published with Adis International Ltd. The Journal's web site is located at http://www.springer.com/adis/journal/40264
Citation
Drug Safety, 2020, Epub 2020-06-18 How to Cite?
AbstractIntroduction: Outcomes associated with suboptimal use of antithrombotic treatments (antiplatelets, warfarin, direct oral anticoagulants [DOACs]) are unclear in Chinese patients with atrial fibrillation (AF). Objectives: Our objective was to assess the prescription patterns, quality, effectiveness, and safety of antithrombotic treatments. Methods: This was a population-based cohort study using electronic health records in Hong Kong. Patients newly diagnosed with AF during 2010–2016 were followed up until 2017. Patients at high stroke risk (CHA2DS2-VASc score ≥ 2) and receiving antithrombotic treatments were matched using propensity scoring. We used Cox proportional hazards regression to compare the risks of ischemic stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), and all-cause mortality between groups. Results: Of the 52,178 high-risk patients with AF, 27,614 (52.9%) received antithrombotic treatment and were included in the analyses. Between 2010 and 2016, prescribing of antiplatelets and warfarin declined and that of DOACs increased dramatically (from 1 to 32%). Two-thirds of warfarin users experienced poor anticoagulation control. Warfarin and DOACs were associated with lower risks of ischemic stroke (warfarin, hazard ratio [HR] 0.51 [95% confidence interval (CI) 0.36–0.71]; DOACs, HR 0.69 [95% CI 0.51–0.94]) and all-cause mortality (warfarin, HR 0.47 [95% CI 0.39–0.57]; DOACs, HR 0.45 [95% CI 0.37–0.55]) than were antiplatelets. DOACs were associated with a lower risk of ICH than was warfarin (HR 0.53 [95% CI 0.34–0.83]). GIB risks were similar among all groups. Conclusion: Antiplatelet prescribing and suboptimal warfarin management remain common in Chinese patients with AF at high risk of stroke. DOAC use may be associated with a lower risk of ischemic stroke and all-cause mortality when compared with antiplatelets and with a lower risk of ICH when compared with warfarin.
Persistent Identifierhttp://hdl.handle.net/10722/284834
ISSN
2019 Impact Factor: 3.442
2015 SCImago Journal Rankings: 1.359

 

DC FieldValueLanguage
dc.contributor.authorLi, X-
dc.contributor.authorPathadka, S-
dc.contributor.authorMan, KKC-
dc.contributor.authorNG, VWS-
dc.contributor.authorSiu, CW-
dc.contributor.authorWong, ICK-
dc.contributor.authorChan, EW-
dc.contributor.authorLau, WCY-
dc.date.accessioned2020-08-07T09:03:14Z-
dc.date.available2020-08-07T09:03:14Z-
dc.date.issued2020-
dc.identifier.citationDrug Safety, 2020, Epub 2020-06-18-
dc.identifier.issn0114-5916-
dc.identifier.urihttp://hdl.handle.net/10722/284834-
dc.description.abstractIntroduction: Outcomes associated with suboptimal use of antithrombotic treatments (antiplatelets, warfarin, direct oral anticoagulants [DOACs]) are unclear in Chinese patients with atrial fibrillation (AF). Objectives: Our objective was to assess the prescription patterns, quality, effectiveness, and safety of antithrombotic treatments. Methods: This was a population-based cohort study using electronic health records in Hong Kong. Patients newly diagnosed with AF during 2010–2016 were followed up until 2017. Patients at high stroke risk (CHA2DS2-VASc score ≥ 2) and receiving antithrombotic treatments were matched using propensity scoring. We used Cox proportional hazards regression to compare the risks of ischemic stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), and all-cause mortality between groups. Results: Of the 52,178 high-risk patients with AF, 27,614 (52.9%) received antithrombotic treatment and were included in the analyses. Between 2010 and 2016, prescribing of antiplatelets and warfarin declined and that of DOACs increased dramatically (from 1 to 32%). Two-thirds of warfarin users experienced poor anticoagulation control. Warfarin and DOACs were associated with lower risks of ischemic stroke (warfarin, hazard ratio [HR] 0.51 [95% confidence interval (CI) 0.36–0.71]; DOACs, HR 0.69 [95% CI 0.51–0.94]) and all-cause mortality (warfarin, HR 0.47 [95% CI 0.39–0.57]; DOACs, HR 0.45 [95% CI 0.37–0.55]) than were antiplatelets. DOACs were associated with a lower risk of ICH than was warfarin (HR 0.53 [95% CI 0.34–0.83]). GIB risks were similar among all groups. Conclusion: Antiplatelet prescribing and suboptimal warfarin management remain common in Chinese patients with AF at high risk of stroke. DOAC use may be associated with a lower risk of ischemic stroke and all-cause mortality when compared with antiplatelets and with a lower risk of ICH when compared with warfarin.-
dc.languageeng-
dc.publisherSpringer, co-published with Adis International Ltd. The Journal's web site is located at http://www.springer.com/adis/journal/40264-
dc.relation.ispartofDrug Safety-
dc.rightsThis is a post-peer-review, pre-copyedit version of an article published in [insert journal title]. The final authenticated version is available online at: https://doi.org/[insert DOI]-
dc.subjectAtrial Fibrillation-
dc.subjectAnticoagulant Agent-
dc.subjectWarfarin-
dc.titleComparative Outcomes Between Direct Oral Anticoagulants, Warfarin, and Antiplatelet Monotherapy Among Chinese Patients with Atrial Fibrillation: A Population-Based Cohort Study-
dc.typeArticle-
dc.identifier.emailLi, X: sxueli@hku.hk-
dc.identifier.emailPathadka, S: swathip@hku.hk-
dc.identifier.emailMan, KKC: mkckth@hku.hk-
dc.identifier.emailSiu, CW: cwdsiu@hkucc.hku.hk-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.emailChan, EW: ewchan@hku.hk-
dc.identifier.emailLau, WCY: wallisy@hku.hk-
dc.identifier.authorityLi, X=rp02531-
dc.identifier.authoritySiu, CW=rp00534-
dc.identifier.authorityWong, ICK=rp01480-
dc.identifier.authorityChan, EW=rp01587-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s40264-020-00961-0-
dc.identifier.scopuseid_2-s2.0-85086655238-
dc.identifier.hkuros311605-
dc.identifier.volumeEpub 2020-06-18-
dc.publisher.placeNew Zealand-

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