TY - JOUR
T1 - Bleeding risk with dabigatran, rivaroxaban, warfarin, and antiplatelet agent in asians with non-valvular atrial fibrillation
AU - Chan, Yi Hsin
AU - Yeh, Yung Hsin
AU - Tu, Hui Tzu
AU - Kuo, Chi Tai
AU - Chang, Shang Hung
AU - Wu, Lung Sheng
AU - Lee, Hsin Fu
AU - See, Lai Chu
N1 - Publisher Copyright:
© Chan et al.
PY - 2017
Y1 - 2017
N2 - It is not understood if dabigatran or rivaroxaban are superior to antiplatelet agents (AA) for safety outcomes in Asians with non-valvular atrial fibrillation (NVAF). In this study we evaluated the bleeding risk of dabigatran, rivaroxaban, warfarin and AA in Asians with NVAF. This national retrospective cohort study analyzed 6,600, 3,167, 5,338 and 8,238 consecutive NVAF patients taking dabigatran, rivaroxaban, warfarin or AAs (including aspirin, clopidogrel or ticlopidine), respectively, from June 1, 2012 to December 31, 2013. Propensity-score weighting was used to balance covariates across study groups. Patients were followed until the first occurrence of any bleeding outcome or the end of the study. The CHA2DS2-VASc scores were 4.1±1.6, 4.1±1.6, 3.3±1.8 and 2.4±1.6 for the dabigatran, rivaroxaban, warfarin, and AA groups, respectively. There were 5,822 (88.2%) and 164 (5.2%) patients taking low dose dabigatran and rivaroxaban, respectively. Hazard ratios (95% confidence intervals) for dabigatran, rivaroxaban, or warfarin versus AA were: intracranial hemorrhage, 0.36 (0.23-0.57;P < 0 . 0001), 0.25 (0.10-0.64;P=0.0037) and 1.34 (0.89-2.02;P=0.1664); gastrointestinal bleeding, 0.44 (0.32-0.59;P < 0 . 0001), 1.09 (0.61- 1.93;P=0.7694), and 0.68 (0.49-0.94;P=0.0189); and all hospitalized major bleeding, 0.41 (0.32-0.53;P < 0 . 0001), 0.65 (0.41-1.03;P=0.0644) and 0.90 (0.70-1.16;P=0.4130) after adjustment. The risk reduction of all major bleeding for dabigatran versus AA persisted on subgroup analysis. In conclusion, we observed that dabiagtran was associated with a lower risk of all major bleeding in Asians with NVAF, whereas rivaroxaban had a similar risk of all major bleeding compared with antiplatelet agents after adjustment of comorbidities.
AB - It is not understood if dabigatran or rivaroxaban are superior to antiplatelet agents (AA) for safety outcomes in Asians with non-valvular atrial fibrillation (NVAF). In this study we evaluated the bleeding risk of dabigatran, rivaroxaban, warfarin and AA in Asians with NVAF. This national retrospective cohort study analyzed 6,600, 3,167, 5,338 and 8,238 consecutive NVAF patients taking dabigatran, rivaroxaban, warfarin or AAs (including aspirin, clopidogrel or ticlopidine), respectively, from June 1, 2012 to December 31, 2013. Propensity-score weighting was used to balance covariates across study groups. Patients were followed until the first occurrence of any bleeding outcome or the end of the study. The CHA2DS2-VASc scores were 4.1±1.6, 4.1±1.6, 3.3±1.8 and 2.4±1.6 for the dabigatran, rivaroxaban, warfarin, and AA groups, respectively. There were 5,822 (88.2%) and 164 (5.2%) patients taking low dose dabigatran and rivaroxaban, respectively. Hazard ratios (95% confidence intervals) for dabigatran, rivaroxaban, or warfarin versus AA were: intracranial hemorrhage, 0.36 (0.23-0.57;P < 0 . 0001), 0.25 (0.10-0.64;P=0.0037) and 1.34 (0.89-2.02;P=0.1664); gastrointestinal bleeding, 0.44 (0.32-0.59;P < 0 . 0001), 1.09 (0.61- 1.93;P=0.7694), and 0.68 (0.49-0.94;P=0.0189); and all hospitalized major bleeding, 0.41 (0.32-0.53;P < 0 . 0001), 0.65 (0.41-1.03;P=0.0644) and 0.90 (0.70-1.16;P=0.4130) after adjustment. The risk reduction of all major bleeding for dabigatran versus AA persisted on subgroup analysis. In conclusion, we observed that dabiagtran was associated with a lower risk of all major bleeding in Asians with NVAF, whereas rivaroxaban had a similar risk of all major bleeding compared with antiplatelet agents after adjustment of comorbidities.
KW - Atrial fibrillation
KW - Direct thrombin inhibitor
KW - Factor xa inhibitor
KW - Hemorrhage
KW - Warfarin
UR - http://www.scopus.com/inward/record.url?scp=85034980718&partnerID=8YFLogxK
U2 - 10.18632/oncotarget.22026
DO - 10.18632/oncotarget.22026
M3 - 文章
C2 - 29228736
AN - SCOPUS:85034980718
SN - 1949-2553
VL - 8
SP - 98898
EP - 98917
JO - Oncotarget
JF - Oncotarget
IS - 58
ER -