Oral Anticoagulation in Asian Patients With Atrial Fibrillation and a History of Intracranial Hemorrhage
- Authors
- Lee, So-Ryoung; Choi, Eue-Keun; Kwon, Soonil; Jung, Jin-Hyung; Han, Kyung-Do; Cha, Myung-Jin; Oh, Seil; Lip, Gregory Y. H.
- Issue Date
- Feb-2020
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- atrial fibrillation; intracranial hemorrhages; non-vitamin K antagonist oral anticoagulant; oral anticoagulation; stroke; warfarin
- Citation
- STROKE, v.51, no.2, pp.416 - 423
- Journal Title
- STROKE
- Volume
- 51
- Number
- 2
- Start Page
- 416
- End Page
- 423
- URI
- http://scholarworks.bwise.kr/ssu/handle/2018.sw.ssu/38778
- DOI
- 10.1161/STROKEAHA.119.028030
- ISSN
- 0039-2499
- Abstract
- 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 naive 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.
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