Open AccessEfficacy and safety of dabigatran, rivaroxaban, and warfarin for stroke prevention in Chinese patients with atrial fibrillation: the Hong Kong Atrial Fibrillation Project
Author(s) -
Li WenHua,
Huang Duo,
Chiang ChernEn,
Lau ChuPak,
Tse HungFat,
Chan Esther W.,
Wong Ian C.K.,
Lip Gregory Y. H.,
Chan PakHei,
Siu ChungWah
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22649
Subject(s) - medicine , rivaroxaban , dabigatran , warfarin , atrial fibrillation , stroke (engine) , incidence (geometry) , vitamin k antagonist , anesthesia , cardiology , mechanical engineering , optics , engineering , physics
Background Little is known about the comparative effectiveness and safety of non–vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin in Chinese atrial fibrillation ( AF ) patients. Our aim was to compare the ischemic stroke risk reduction and incidence of intracranial hemorrhage ( ICH ) of warfarin in relation to quality of anticoagulation control (as reflected by time in therapeutic range [ TTR ]), and to dabigatran and rivaroxaban in a real‐world cohort of Chinese AF patients. Hypothesis NOAC, rather than warfarin, is preferred in Chinese AF patients. Methods Of 2099 patients studied (73.1 ± 12.3 years, female: 44.6%, CHA 2 DS 2 ‐VASc 3.7 ± 1.9 and HAS‐BLED 2.0 ± 1.0) with nonvalvular AF , 963 patients (45.9%) were on warfarin (only 16.3% had TTR ≥65%), 669 patients were on rivaroxaban, and 467 patients were on dabigatran. Results After a mean follow‐up of 21.7 ± 13.4 months, there were 156 ischemic strokes (annual incidence of 4.10%/year), with the incidence of ischemic stroke being highest in patients on warfarin with TTR <65% (5.24%/year), followed by those on rivaroxaban (3.74%/year), and those on warfarin with TTR ≥65% (3.35%/year), whereas patients on dabigatran had the lowest incidence of ischemic stroke (1.89%/year). The incidence of ICH was lowest in patients on dabigatran (0.39%/year) compared with those on rivaroxaban (0.52%/year) and warfarin, with TTR <65% (0.95%/year) and TTR ≥65% (0.58%/year). Patients on rivaroxaban 20 mg daily had similar ischemic stroke risk (1.93%/year) and ICH risk (0.21%/year) compared to dabigatran. Conclusions In Chinese AF patients, the benefits of warfarin therapy for stroke prevention and ICH reduction depend on TTR . Of the treatments compared, dabigatran, as well as rivaroxaban 20 mg daily, was associated with lowest ischemic stroke and ICH rates.