Open AccessEfficacy and safety of NOAC versus warfarin in AF patients with left atrial enlargement
Author(s) -
Victor ChienChia Wu,
Chunli Wang,
ShuTing Gan,
Michael Wu,
Shaowei Chen,
ChangFu Kuo,
YuTung Huang,
MingShien Wen,
ShangHung Chang
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0243866
Subject(s) - medicine , warfarin , atrial fibrillation , left atrial enlargement , embolism , stroke (engine) , cardiology , stenosis , surgery , mechanical engineering , sinus rhythm , engineering
Background Little is known about the effects of anticoagulation in patients with atrial fibrillation (AF) and left atrial enlargement (LAE). Methods Data of patients with AF were retrieved from Chang Gung Research Database during 2007–2016. We excluded patients who were not using oral anticoagulants, used anticoagulants for <30 days, used ≥2 agents concomitantly or switched anticoagulants, had left atrial diameter missing from their data, were aged <65, had received valve surgeries, had mitral stenosis, or had a history of cancer. The primary outcomes were ischemic stroke (IS)/systemic embolism (SE), major bleeding, and death from any cause. Results We identified 40,777 patients who received a diagnosis of AF. After the exclusion criteria were applied, 6,445 patients remained, 4,922 with LAE, and they were followed up for 2.4 ±1.9 years. The mean age of the patients was 77.32 ± 0.18 in the NOAC group and 76.58 ± 6.91 in the warfarin group ( p < 0.0001); 48.24% of patients in the NOAC group and 46.98% of patients in the warfarin group were men ( p > 0.05). The mean CHA 2 DS 2 -VASc score was 3.26 ± 1.05 in the NOAC group and 3.07 ± 1.12 in the warfarin group ( p < 0.0001). The mean HAS-BLED score was 3.87 ± 3.81 in the NOAC group and 3.86 ± 3.80 in the warfarin group ( p > 0.05). Furthermore, the mean LA diameter was 4.75 ± 0.63 cm in the warfarin group and 4.79 ± 0.69 cm in the warfarin group ( p > 0.05). Among patients with LAE, NOAC was associated with significantly reduced IS/SE events (CRR = 0.63, 95% CI = 0.52–0.77), no difference in major bleeding (CRR = 0.91, 95% CI = 0.78–1.05), and significantly reduced death from any cause (aHR = 0.65, 95% CI = 0.52–0.80) compared with warfarin. Conclusions In elderly patients with AF and LAE, NOAC was associated with reduced IS/SE and death from any cause compared with warfarin, whereas no difference in major bleeding was observed between these treatments.