scholarly journals Letter by Liang et al Regarding Article, “Oral Anticoagulation in Asian Patients With Atrial Fibrillation and a History of Intracranial Hemorrhage”

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
Author(s):  
Bo Liang ◽  
Yu-Xiu Zhao ◽  
Ning Gu
Keyword(s):  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Oral Anticoagulation ◽  
Asian Patients ◽  
History Of

scholarly journals Oral Anticoagulation in Asian Patients With Atrial Fibrillation and a History of Intracranial Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 416-423 ◽  
Author(s):  
So-Ryoung Lee ◽  
Eue-Keun Choi ◽  
Soonil Kwon ◽  
Jin-Hyung Jung ◽  
Kyung-Do Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Intracranial Hemorrhage ◽  
Asian Population ◽  
Prior History ◽  
Composite Outcome ◽  
Propensity Score Weighting ◽  
Asian Patients ◽  
History Of

Background and Purpose— Warfarin is associated with a better net clinical benefit compared with no treatment in patients with nonvalvular atrial fibrillation (AF) and history of intracranial hemorrhage (ICH). There are limited data on nonvitamin K antagonist oral anticoagulants (NOACs) in these patients, especially in the Asian population. We aimed to compare the effectiveness and safety of NOACs to warfarin in a large-scale nationwide Asian population with AF and a history of ICH. Methods— Using the Korean Health Insurance Review and Assessment database from January 2010 to April 2018, we identified patients with oral anticoagulant naïve nonvalvular AF with a prior spontaneous ICH. For the comparisons, warfarin and NOAC groups were balanced using propensity score weighting. Ischemic stroke, ICH, composite outcome (ischemic stroke+ICH), fatal ischemic stroke, fatal ICH, death from composite outcome, and all-cause death were evaluated as clinical outcomes. Results— Among 5712 patients with AF with prior ICH, 2434 were treated with warfarin and 3278 were treated with NOAC. Baseline characteristics were well-balanced after propensity score weighting (mean age 72.5 years and CHA 2 DS 2 -VASc score 4.0). Compared with warfarin, NOAC was associated with lower risks of ischemic stroke (hazard ratio [HR], 0.77 [95% CI, 0.61–0.97]), ICH (HR, 0.66 [95% CI, 0.47–0.92]), and composite outcome (HR, 0.73 [95% CI, 0.60–0.88]). NOAC was associated with lower risks of fatal stroke (HR, 0.54 [95% CI, 0.32–0.89]), death from composite outcome (HR, 0.53 [95% CI, 0.34–0.81]), and all-cause death (HR, 0.83 [95% CI, 0.69–0.99]) than warfarin. NOAC showed nonsignificant trends toward to reduce fatal ICH compared with warfarin (HR, 0.47 [95% CI, 0.20–1.03]). Conclusions— NOAC was associated with a significant lower risk of ICH and ischemic stroke compared with warfarin. NOAC might be a more effective and safer treatment option for Asian patients with nonvalvular AF and a prior history of ICH.

scholarly journals Thrombotic Profile and Oral Anticoagulation in Asian and Non-Asian Patients With Nonvalvular Atrial Fibrillation

2019 ◽  
Vol 74 (22) ◽  
pp. 2822-2824 ◽  
Author(s):  
Ying X. Gue ◽  
Nobutaka Inoue ◽  
Nikolaos Spinthakis ◽  
Asumi Takei ◽  
Hiroyuki Takahara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Nonvalvular Atrial Fibrillation ◽  
Asian Patients

scholarly journals Association of Preceding Antithrombotic Therapy in Atrial Fibrillation Patients With Ischemic Stroke, Intracranial Hemorrhage, or Gastrointestinal Bleed and Mortality

2019 ◽  
Author(s):  
Joris J Komen ◽  
Tomas Forslund ◽  
Aukje K Mantel-Teeuwisse ◽  
Olaf H Klungel ◽  
Mia von Euler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Intracranial Hemorrhage ◽  
Cox Regression ◽  
Mortality Rates ◽  
Antithrombotic Treatment ◽  
Healthcare Database ◽  
Gastrointestinal Bleed ◽  
History Of

Abstract Aims To analyze 90-day mortality in AF patients after a stroke or a severe bleed and assess associations with the type of antithrombotic treatment at the event. Methods and Results From the Stockholm Healthcare database, we selected 6 017 patients with a known history of AF who were diagnosed with ischemic stroke, 3 006 with intracranial hemorrhage, and 4 291 with a severe gastrointestinal bleed (GIB). The 90-day mortality rates were 25.1% after ischemic stroke, 31.6% after intracranial hemorrhage, and 16.2% after severe GIB. We used Cox regression and propensity score matched analyses to test the association between antithrombotic treatment at the event and 90-day mortality. After intracranial hemorrhage, there was a significantly higher mortality rate in warfarin compared to NOAC treated patients (adjusted hazard ratio (aHR): 1.36 CI: 1.04 – 1.78). After an ischemic stroke and a severe GIB, patients receiving antiplatelets or no antithrombotic treatment had significantly higher mortality rates compared to patients on NOACs, but there was no difference comparing warfarin to NOACs (aHR 0.84 CI: 0.63 – 1.12 after ischemic stroke, aHR 0.91 CI: 0.66 – 1.25 after severe GIB). Propensity score matched analysis yielded similar results. Conclusion Mortality rates were high in AF patients suffering from an ischemic stroke, an intracranial hemorrhage, or a severe GIB. NOAC treatment was associated with a lower 90 day mortality after intracranial hemorrhage than warfarin.

Qualität des Antikoagulationsmanagements bei ambulanten Patienten mit Vorhofflimmern

Praxis ◽  
2003 ◽  
Vol 92 (21) ◽  
pp. 991-995 ◽  
Author(s):  
Gubler ◽  
Martina ◽  
Arpagaus ◽  
Dieterle
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Oral Anticoagulation ◽  
Medical Emergency ◽  
Psychiatric Disease ◽  
Recurrent Falls ◽  
History Of ◽  
Acute Condition

Many patients with atrial fibrillation do not receive anticoagulation due to accepted contraindications but also due to considerable underuse. We screened 2215 consecutive patients when they entered the Medical Emergency Department for any acute condition. The decision on correct use or underuse of oral anticoagulation was made from the charts by consensus of two experienced physicians. The prevalence of atrial fibrillation was 3.7%. 43 of 83 patients with atrial fibrillation had oral anticoagulation (52%, mean age 76 years). 32 patients were treated with Aspirin only (38%, mean age 79 years). 29 patients (35%) did not receive anticoagulation because of accepted contraindications, i.e., dementia and risk for recurrent falls (n = 16), history of bleeding (n = 6), drug malcompliance due to forgetfulness (n = 4) and psychiatric disease (n = 1). Underuse of anticoagulation occurred only in three patients (4%, unclear reasons in two patients, patient's unwillingness in one patient). Conclusion: We did not observe substantial underuse of anticoagulation in patients with atrial fibrillation.

Stroke prevention in atrial fibrillation: An Asian perspective

2014 ◽  
Vol 111 (05) ◽  
pp. 789-797 ◽  
Author(s):  
Kang-Ling Wang ◽  
Gregory Y. H. Lip ◽  
Chern-En Chiang
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Asian Patients ◽  
History Of ◽  
Randomised Controlled ◽  
Similar Risk ◽  
Selection Of

SummaryAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia. In 2050, it is estimated that there will be 72 million AF patients in Asia, accounting for almost 2.9 million patients suffering from AF-associated stroke. Asian AF patients share similar risk factor profiles as non-Asians, except that more Asians have a history of previous stroke. Clinical challenges are evident in the field of stroke prevention in AF, amongst Asians. Existing stroke and bleeding risk scores have not been well-validated in Asians. Asians are prone to bleeding when treated with warfarin, and the optimal international normalised ratio (INR) for warfarin use is yet to be determined in Asians, though Asian physicians tend to keep it in a lower range (e.g. INR 1.6–2.6) for elderly patients despite limited evidence to justify this. In general, warfarin is ‘difficult’ to use in Asians due to higher risk of bleeding and higher stroke rate in Asians than in non-Asians, as shown in randomised controlled trials. Excess of bleeding was not found in Asians when novel oral anticoagulants (NOACs) were used. Besides, the superiority of NOACs to warfarin in reducing thromboembolism was maintained in Asians. Therefore NOACs are preferentially indicated in Asians in terms of both efficacy and safety. Also, some preliminary data suggest that Asian patients with AF might not be the same. Future prospective randomised trials are needed for the selection of NOACs according to different ethnic background.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

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