Anticoagulation Management With Coumarinic Drugs in Chilean Patients

Warfarin and acenocoumarol are used in various cardiovascular disorders to improve the prognosis of patients with thromboembolic disease. However, there is a lack of substantial efficacy and safety data on antithrombotic prophylaxis in several countries, particularly in Latin America. The aim of this study was to provide information about the efficacy of anticoagulants in Chilean patients. Data were collected from databases of the Western Metropolitan Health Service, Santiago, Chile. We identified 6280 records of patients receiving anticoagulant treatment. The three most common diagnoses were rhythm disorder (43.7%), venous thrombosis (22%), and valvular prosthesis (10.7%). The majority of patients (98.5%) received acenocoumarol while 1.5% of patients received warfarin, at weekly therapeutic doses of 13.6 mg and 30.4 mg, respectively. For total diagnoses, the median time in the therapeutic range was 50%. However, better results, 66.7%, were observed when a telemedicine strategy was used only in Santiago Province. Our findings emphasize that in Chile, where the number of patients receiving anticoagulant treatment increases every year, telemedicine, by committed teams, improves the use of oral anticoagulants and is able to increase quality indicators of anticoagulant treatment care.

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The Ottawa Hospital Regional Warfarin Anticoagulation Management Service. Efficacy and a Patient Satisfaction Survey

Blood ◽

10.1182/blood.v124.21.3517.3517 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3517-3517

Author(s):

Dimitrios Scarvelis

Keyword(s):

Patient Satisfaction ◽

Therapeutic Range ◽

Oral Anticoagulants ◽

Satisfaction Survey ◽

Management Service ◽

Anticoagulation Management ◽

Ottawa Hospital ◽

Patient Satisfaction Survey ◽

Number Of Patients ◽

Anticoagulation Management Service

Background: 5% of the population over 65 is on oral anticoagulant therapy. The indications for anticoagulation therapy are wide, not limited to but including treatment of arterial and venous thrombosis, and primary stroke prophylaxis is patients with atrial fibrillation and mechanical cardiac valves. While new oral anticoagulants not requiring monitoring are being more widely prescribed, vitamin K antagonists (VKA) are still being used for many patients in whom the novel agents are contra-indicated (renal failure), not available (funding), or patient/physician preference. Most patients on VKA have their family physicians manage their oral anticoagulants. On average, the time in therapeutic range achieved by family physicians is low (50-55%). There is also a number of patients who have no family physician and are either taking VKA without monitoring, or are having their anticoagulants monitored routinely though emergency room physicians/visits. The Ottawa Hospital (TOH) anticoagulation management service is an e-health solution that offers patients world beating time in therapeutic range (TIR). TOH uses a pharmacy managed DAWN software package (computer-assisted warfarin dosing program). Maintaining patients in therapeutic range for a high percentage of time (greater than 70%) can reduce the risk or recurrent thrombosis (venous or arterial) from under-anticoagulation and the risk of bleeding complications from over-anticoagulation. Well managed VKA therapy has also been suggested to be as safe as therapy with novel oral anticoagulants in some subgroup analysis of studies investigating the novel oral anticoagulants. Objectives/Methods: The purpose of this study was to bring the benefits of the TOH experience to provide a Regional Anticoagulation Management Service across a wide region of eastern Ontario, Canada. This service includes remote blood testing (at a lab near the patient’s home), integrated LIS link to a computerized dosing system (possible through a commercial lab partnership), and communication of dosing and testing instructions via interactive voice recognition (IVRS), email, or live (pharmacist/pharmacist assistant). We administered a patient satisfaction survey to a sample of 111 patients enrolled in the service as well as reported TIR for patients enrolled in our service during the study period (2009-2011). Results: At the beginning of the study, 1400 patients were enrolled in the program. After 2 years, the number has increased to by 66% to 2325. The average TIR for patients in the program as of October 2011 was 76.3% (overall), 77.8% (IVRS), 76.8% (email), and 73.3% (live). The patient satisfaction survey demonstrated that 94% patients prefer VKA anticoagulation monitoring through TOH service compared to their previous experience. 84% patients either satisfied or very satisfied with VKA anticoagulation care through TOH service (compared to 53% satisfaction with anticoagulant care prior to enrolling in our program). Conclusions: The TOH model of anticoagulation management service results in excellent VKA monitoring (high TIR) for a large number of patients across a wide geographical area, as well as a high level of patient satisfaction. This service allows for the safe and efficient management of VKAs in patients in whom VKA therapy is indicated. Disclosures No relevant conflicts of interest to declare.

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Przewlekłe leczenie przeciwkrzepliwe

Acta Haematologica Polonica ◽

10.2478/ahp-2018-0009 ◽

2018 ◽

Vol 49 (2) ◽

pp. 47-49 ◽

Cited By ~ 1

Author(s):

Krystyna Zawilska

Keyword(s):

Pulmonary Embolism ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Compression Therapy ◽

Good Choice ◽

Anticoagulant Treatment ◽

Efficacy And Safety ◽

Risk Of Bleeding

AbstractUnprovoked venous thromboembolism (VTE) - proximal venous thrombosis or pulmonary embolism - should be treated either 3 months or indefinitely if the risk of bleeding is low. This article summarizes the efficacy and safety of extended therapy of VTE with direct oral anticoagulants (DOAC) in comparison with warfarin, as well as the role of of acetylsalicylic acid (ASA) for the long-term prevention of recurrent VTE. As the Survet study showed, for some patients who have already completed at least 6 months of anticoagulant treatment for their index VTE event, an oral glycosaminoglycan - sulodexide associated with compression therapy is a good choice, because it decreases the incidence of recurrences of VTE without detectable risks for the patients’ safety.

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Optimization of Pharmacotherapy with Direct Oral Anticoagulants: the Need to Choose the Right Dosage Regimen

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-4-593-603 ◽

2019 ◽

Vol 15 (4) ◽

pp. 593-603

Author(s):

A. I. Kochetkov ◽

O. D. Ostroumova

Keyword(s):

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Coronary Intervention ◽

International Normalized Ratio ◽

Efficacy And Safety ◽

High Efficacy ◽

Drug Label ◽

Coronary Syndrome ◽

Number Of Patients

In recent years, there has been a persistent trend towards the more frequent prescription of direct oral anticoagulants (DOACs) compared with vitamin K antagonists due to the extensive body of evidence showing their high safety and efficacy, which in some cases exceed those of warfarin, and also by reason of there is no necessity for regular monitoring of international normalized ratio. However, the question of the reasonable and rational prescription of DOACs becomes relevant, including issues of their dosing, especially as a result of increasing in the number of patients with a complex cardiovascular risk profile and multimorbidity. In these terms, apixaban stands high among the DOAC class, and its high efficacy and safety both in full dose and reasonably reduced dosage has been proved, including older patients, patients with chronic kidney disease, coronary artery disease, with history of acute coronary syndrome and individuals undergoing percutaneous coronary intervention. This DOAC has strict indications to reduce the dose, they are specified in the drug label, and in such cases a reduced dose should be prescribed, in these clinical conditions the effectiveness and safety of apixaban is also proven. The favorable apixaban pharmacokinetic properties, consisting in low renal clearance, lack of clinically relevant interaction with food and the linear smooth effect on the blood coagulation components without episodes of hypo- and hypercoagulation, are the most important components of high efficacy and safety of this DOAC. The optimal efficacy and safety coupling of apixaban is reflected in the exclusively high patients’ adherence to the treatment confirmed by evidence-based medicine data, and therefore there is no necessity for additional procedures to maintain adherence. All the aforementioned facts allow us to recommend apixaban for widespread use in patients requiring anticoagulant therapy for optimal prevention of systemic thromboembolism and minimizing the associated risk of bleeding.

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Anticoagulation in Deep Venous Thrombosis: Current Trends in the Era of Non- Vitamin K Antagonists Oral Anticoagulants

Current Pharmaceutical Design ◽

10.2174/1381612826666200420150517 ◽

2020 ◽

Vol 26 (23) ◽

pp. 2692-2702 ◽

Cited By ~ 1

Author(s):

Panteleimon E. Papakonstantinou ◽

Costas Tsioufis ◽

Dimitris Konstantinidis ◽

Panagiotis Iliakis ◽

Ioannis Leontsinis ◽

...

Keyword(s):

Cancer Patients ◽

Vitamin K ◽

Safety Profile ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Bleeding Risk ◽

Efficacy And Safety ◽

Anticoagulation Management ◽

Oral Agents

: Anticoagulation therapy is the cornerstone of treatment in acute vein thrombosis (DVT) and it aims to reduce symptoms, thrombus extension, DVT recurrences, and mortality. The treatment for DVT depends on its anatomical extent, among other factors. Anticoagulation therapy for proximal DVT is clearly recommended (at least for 3 months), while AT for isolated distal DVT should be considered, especially in the presence of high thromboembolic risk factors. The optimal anticoagulant and duration of therapy are determined by the clinical assessment, taking into account the thromboembolic and bleeding risk in each patient in a case-by-case decision making. Non-Vitamin K antagonists oral anticoagulants (NOACs) were a revolution in the anticoagulation management of DVT. Nowadays, NOACs are considered as first-line therapy in the anticoagulation therapy for DVT and are recommended as the preferred anticoagulant agents by most scientific societies. NOACs offer a simple route of administration (oral agents), a rapid onset-offset of their action along with a good efficacy and safety profile in comparison with Vitamin K Antagonists (VKAs). However, there are issues about their efficacy and safety profile in specific populations with high thromboembolic and bleeding risks, such as renal failure patients, active-cancer patients, and pregnant women, in which VKAs and heparins were the standard care of treatment. Since the available data are promising for the use of NOACs in end-stage chronic kidney disease and cancer patients, several ongoing randomized trials are currently trying to solve that issues and give evidence about the safety and efficacy of NOACs in these populations.

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Comparative efficacy and safety of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban in preclinical and clinical development

Thrombosis and Haemostasis ◽

10.1160/th09-09-0659 ◽

2010 ◽

Vol 103 (03) ◽

pp. 572-585 ◽

Cited By ~ 75

Author(s):

Mike Ufer

Keyword(s):

Oral Anticoagulants ◽

Safety Data ◽

Factor Xa ◽

Clinical Development ◽

Phase Iii ◽

Coagulation Cascade ◽

Bleeding Complications ◽

Thrombin Inhibitor ◽

Factor Xa Inhibitor ◽

Efficacy And Safety

SummaryTherapeutic oral anticoagulation is still commonly achieved by administration of warfarin or other vitamin K antagonists that are associated with an untoward pharmacokinetic / pharmacodynamic (PK/PD) profile leading to a high incidence of bleeding complications or therapeutic failure. Hence, there is an unmet medical need of novel easy-to-use oral anticoagulants with improved efficacy and safety. Recent developments include the identification of non-peptidic small-molecules that selectively inhibit certain serine proteases within the coagulation cascade. Of these, the thrombin inhibitor dabigatran and factor Xa inhibitor rivaroxaban have recently been licensed for thromboprophylaxis after orthopaedic surgery mainly in Europe. In addition, the factor Xa inhibitor apixaban is in late-stage clinical development. Each drug is prescribed at fixed doses without the need of anticoagulant monitoring. Phase III trials in orthopaedic patients essentially resulted in non-inferior efficacy of dabigatran and superior efficacy of rivaroxaban over enoxaparin without any marked differences of drug safety, while apixaban data is still controversial. However, alterations of rivaroxaban and apixaban pharmacokinetics upon interactions with inhibitors and inducers of CYP3A4 or P-glycoprotein may complicate the use of these compounds in daily practice, whereas dabigatran elimination largely depends on renal function. Hence, this review reports PK/PD, efficacy and safety data of dabigatran, rivaroxaban and apixaban throughout preclinical and clinical development.

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Implementation of a standardised annual anticoagulation specialist review in primary care

Primary Health Care Research & Development ◽

10.1017/s1463423620000171 ◽

2020 ◽

Vol 21 ◽

Author(s):

Nathan W. Hutchinson-Jones ◽

Sophie K. Didcott ◽

Matthew D. Jones ◽

Josephine N. Crowe

Keyword(s):

Primary Care ◽

Secondary Care ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Management ◽

Risk Of Bleeding ◽

Number Of Patients ◽

Before And After ◽

Inflammatory Drugs ◽

Preventable Harm

Abstract An increasing number of patients are being prescribed direct oral anticoagulants (DOACs), while the patients who remain on warfarin are becoming more complex. There is currently a lack of a standardised anticoagulation review for patients in primary care, resulting in potentially preventable harm events. Our aim was to implement a new service, where a standardised review is carried out by a specialist multidisciplinary secondary care anticoagulation team. Overall, the implementation of a standardised review resulted in better optimisation of anticoagulation management for patients taking either a DOAC or a warfarin. Of the 172 eligible patients prescribed warfarin, 47 (27%) chose to switch a DOAC. The average time in therapeutic range for patients on warfarin before and after the pilot increased from 73.5% to 75%. Of 482 patients taking a DOAC, 35 (7%) were found to be on incorrect dose. In 32 (91%) of 35 patients, the dose was amended after notifying the patient’s general practitioner. We also found a significant number of patients inappropriately prescribed concomitant medication such as antiplatelet or non-steroidal anti-inflammatory drugs, potentially putting the patients at an elevated risk of bleeding. While further research is needed; we believe the results of this pilot can be used to help build a case to influence the commissioning of anticoagulation services. Secondary care anticoagulation teams, like our own, may be well-placed to provide or support such services, by working across the primary care and secondary care interface to support our primary care colleagues.

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P1256Resumption of anticoagulant treatment in patients with atrial fibrillation following gastrointestinal bleeding: a nationwide cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0214 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Rajan ◽

A N Bonde ◽

J B Olesen ◽

M Lamberts ◽

G Y H Lip ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Gastrointestinal Bleeding ◽

Time Trends ◽

Absolute Risk ◽

Oral Anticoagulants ◽

Anticoagulant Treatment ◽

Number Of Patients ◽

All Cause Mortality ◽

Lower Hazard

Abstract Introduction Following the first gastrointestinal bleeding in a patient with atrial fibrillation (AF) on oral anticoagulant treatment, apprehension of a reoccurrence may prevent clinicians from resuming anticoagulant treatment. However, risk of stroke and thromboembolism in these patients remains substantial. Limited literature exists on resumption patterns of vitamin K antagonists (VKA) and non-VKA oral anticoagulants (NOACs), as well as risks of outcomes associated with treatment compared to discontinuation. Purpose We investigated time trends of resumption of NOACs and VKA, and second, risks of recurrent gastrointestinal bleeding, stroke/thromboembolism and all-cause mortality associated with resumption of NOACs and VKA compared with non-resumption. Methods This study was based on a nationwide cohort study using Danish registries, from 1st January 2005 to 31st July 2017. All patients diagnosed with AF and receiving oral anticoagulants prior to admission to hospital with gastrointestinal bleeding were included. Follow-up began 90 days post discharge and patients were categorised in groups of non-resumption, resumption of NOAC, or resumption of VKA. Trends from 2005 to 2017 of resumption of oral anticoagulants were tested using Cochran-Armitage trend tests. Outcomes of interest included recurrent gastrointestinal bleeding, stroke/thromboembolism, and all-cause mortality, measured in terms of multiple-adjusted hazard ratios (HR) and standardised absolute risks. Results The study included 4842 patients with AF receiving oral anticoagulants, discharged from hospital after a gastrointestinal bleeding. Time trends showed a decline in non-resumption from 35.2% in 2006 to 16.5% in 2016. Within 90 days following discharge, 16.3% resumed NOACs, 57,9% resumed VKA, and 25,8% did not resume either anticoagulant treatment. Compared with non-resumption, resumption of was associated with lower hazard of all-cause mortality [HR 0.63 (0.54–0.75) and 0.68 (0.56–0.83), respectively] and lower, but not significant, hazard of stroke/thromboembolism [HR of 0.79 (0.52–1.19) and 0.78 (0.48–1.28), respectively]. There is similar hazard of recurrent gastrointestinal bleeding [HR 0.98 (0.75–1.28) and 0.82 (0.59–1.13), respectively]. The figure shows the standardised absolute risk of recurrent gastrointestinal bleeding and stroke/thromboembolism. Standardised Absolute Risks Conclusion(s) The number of patients not resuming anticoagulant treatment has approximately halved over 10 years between 2006 and 2016. Resumption of NOACs and VKA subsequent to gastrointestinal bleeding in patients with AF was associated with lower hazard of all-cause mortality. There is lower, but not significant, hazard of stroke/thromboembolism and similar hazard of recurrent gastrointestinal bleeding with resumption of VKA and NOACs compared to non-resumption, which suggests that apprehension of recurrent gastrointestinal bleeding is insufficient to justify discontinuation of treatment.

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The use of direct oral anticoagulants for thromboprophylaxis or treatment of cancer-associated venous thromboembolism: a meta-analysis and review of the guidelines

Thrombosis Journal ◽

10.1186/s12959-021-00326-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Norah S. Alsubaie ◽

Shahad M. Al Rammah ◽

Reema A. Alshouimi ◽

Mohammed Y. Alzahrani ◽

Majed S. Al Yami ◽

...

Keyword(s):

Venous Thromboembolism ◽

Major Bleeding ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Safety Data ◽

Efficacy And Safety ◽

Patients With Cancer ◽

Common Causes

Abstract Background Venous thromboembolism (VTE) is a common complication among patients with cancer and is one of the most common causes of increased morbidity and mortality. The use of direct oral anticoagulants (DOACs) for thromboprophylaxis and treatment of cancer-associated venous thromboembolism (CA-VTE) has been evaluated in several randomized clinical trials (RCTs). The aim of this meta-analysis was to assess efficacy and safety of using DOACs for thromboprophylaxis and treatment of CA-VTE and provide a summary for available guidelines’ recommendations. Methods MEDLINE was searched to identify studies evaluating the use of DOACs for thromboprophylaxis or treatment in patients with cancer. Search was limited to peer-reviewed studies published in English. Studies were excluded if they were not RCTs or subgroup analyses of data derived from RCTs, if they did not report efficacy and safety data on patients with active cancer, or if they were published as an abstract. New VTE or VTE recurrence, and major or clinically relevant non-major bleeding (CRNMB) were used to assess the efficacy and safety, respectively. The Mantel-Haenszel random-effects model risk ratios (RRs) and the corresponding 95% confidence intervals (CIs) were calculated to estimate the pooled treatment effects of DOACs. Results Four studies evaluating DOACs use for thromboprophylaxis and four – for treatment of CA-VTE were included. Thromboprophylaxis with DOACs was associated with a significant reduction in the risk of symptomatic VTE (RR = 0.58; 95%CI 0.37,0.91) but with an incremental risk of major bleeding or CRNMB (RR = 1.57; 95%CI 1.10,2.26). CA-VTE treatment with DOACs was linked with a significant reduction in VTE recurrence (RR = 0.62; 95%CI 0.44,0.87) but with an incremental risk of CRNMB (RR = 1.58; 95%CI 1.11,2.24). Conclusions The DOACs are associated with a lower risk of symptomatic VTE and VTE recurrence, but the risk of bleeding remains a considerable concern. Clinical decisions should be made by assessing individual patient’s risk of VTE and bleeding.

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Real Life Efficacy and Safety of Rivaroxaban for Extended VTE Treatment – First Results of the Prospective Noac Registry (NCT01588119).

Blood ◽

10.1182/blood.v120.21.2267.2267 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2267-2267

Author(s):

Christina Koehler ◽

Sebastian Werth ◽

Vera Gelbricht ◽

Ulrike Haensel ◽

Luise Tittl ◽

...

Keyword(s):

Oral Anticoagulants ◽

Safety Data ◽

Real Life ◽

Prolonged Treatment ◽

Efficacy And Safety ◽

Bleeding Events ◽

Vascular Events ◽

Daily Care ◽

Short Period

Abstract Abstract 2267 Background: In the EINSTEIN-EXT trial, rivaroxaban (RX) has been found to be at least as effective and safe as warfarin in extended venous thromboembolism (VTE) treatment, which lead to approval in many countries. However, patients in RCT‘s present a selected population treated under a strict protocol and followed for a short period of time. Consequently, efficacy and safety of new oral anticoagulants (NOAC) need to be confirmed in unselected patients in daily care. Objectives: To evaluate the efficacy, safety and management issues of rivaroxaban anticoagulation for extended VTE treatment in daily care. Patients and methods: In the district of Saxony, Germany, a network of 200 physicians from private practice and hospitals enrol patients in the prospective NOAC registry. Inclusion criteria are: 1) indication for NOAC anticoagulation >3 month; 2) age > 18 years; 3) written informed consent; 4) availability for follow-up. No Exclusion criteria apply. In the registry, up to 2000 patients will receive prospective follow up (FU) by phone visits at day 30 day and quarterly thereafter to collect efficacy and safety data. Results: Until July 31th 2012, 938 patients were registered. Of these, 126 patients received RX for extended VTE treatment (demographic data in table 1). In our registry, the population receiving extended VTE treatment is older than in EINSTEIN-EXT (65.0 vs. 58.2 years). Indication for prolonged treatment is proximal deep vein thrombosis or pulmonary embolism (93.3%). Most patients received 20 mg OD, but a quarter of patients received 15 mg OD due to impaired renal function. Until July 31th, completed FU cumulate to 44.2 patient years. The results of 1-, 3- and 6-months FU are shown in table 2. Until now, no recurrent VTE or VTE-related death occurred. Two patients experienced major vascular events (1 ACS, 1 TIA). Bleeding events were frequent (24.6%) but only 2 patients (1.6%) experienced major bleeding events, none of which were fatal. Two patients died due to underlying diseases. At 3 and 6 month, 94% resp. 85% of patients were still taking RX. Conclusion: In unselected patients in daily care, extended VTE treatment with RX is effective and safe with low rates of events or treatment discontinuation in the first 180 days of treatment. Long-term data will be reported. Disclosures: Werth: Bayer Healthcare: Honoraria. Beyer-Westendorf:Bayer Healthcare: Bayer provided a grant to support the NOAC registry in part Other, Honoraria; Boehringer Ingelheim: Boehringer provided a grant to support the NOAC registry in part, Boehringer provided a grant to support the NOAC registry in part Other, Honoraria; Bristol Myers Squibb: Honoraria; Pfizer: Honoraria.

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Abstract 12239: Efficacy and Safety of the Non-vitamin K Antagonist Oral Anticoagulants (NOACs) in Japan: A Retrospective Cohort Study Using the National Database of Health Insurance Claim

Circulation ◽

10.1161/circ.132.suppl_3.12239 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Masahiro Inoue ◽

Yoshinori Miyamoto ◽

Kotaro Yasuda ◽

Shunya Ikeda ◽

Masakazu Nishigaki ◽

...

Keyword(s):

Ischemic Stroke ◽

Health Insurance ◽

Gastrointestinal Hemorrhage ◽

Oral Anticoagulants ◽

Treated Group ◽

Vitamin K Antagonist ◽

National Database ◽

Anticoagulant Treatment ◽

Efficacy And Safety ◽

Insurance Claim

Objective: Examine efficacy and safety of anticoagulation (AC) treatment in Japanese Acute hospitals Methods: Insurance claim data of 66, 693 patients who received anticoagulant treatment were extracted from 352 (20%) of hospitals of all 1580 hospitals enrolled in national database of health insurance, Diagnosis Procedure Combination (DPC) database. All the patients received anticoagulant treatment using warfarin and/or non-vitamin K antagonist oral anticoagulants (NOAC) during 10/1/2012 and 9/30/2014. NOACs in this study are: dabigatran, rivaroxaban, and apixaban. We observed incidence of ischemic stroke as efficacy related outcome. We also observed following unfavorable events: intracranial hemorrhage, gastrointestinal hemorrhage, and all-cause death. Outcomes were compared between group of warfarin-treated patients and NOACs-treated patients. Findings: Of 66,693 patients treated with anticoagulants, 50,523(77.3%) were treated with Warfarin, 16,170(24.8%) were with NOACs. Among 66,693 patients, 1,378 patients (2.1%) who were treated with both drugs were excluded for the analysis. The event rate of ischemic stroke was similar between warfarin-treated group and NOACs-treated group 849 (1.68%) vs 245 (1.52%), respectively (p=0.16). On the other hands, unfavorable events were observed significantly more frequently in warfarin-treated group than NOACs-treated group: all-cause death, 4,875(9.6%) vs 724(4.5%), respectively (p<0.001); intracranial hemorrhage, 685(1.4%) vs 94(0.6%), respectively (p<0.001); gastrointestinal hemorrhage, 883 (1.74%) vs 157 (0.97%), p<0.001). Conclusions: This retrospective study based on large-scale national database revealed that efficacy of warfarin and NOACs were equivalent. However, risk of all-cause death and unfavorable bleeding events was higher in warfarin-treated patients than NOACs-treated patients. This study demonstrates that NOACs contribute a beneficial effect on anticoagulation treatment for the patients with atrial fibrillation in the real world.

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