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Safety and Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Patients With Atrial Fibrillation and Anemia: A Retrospective Cohort Study.
| Content Provider | Europe PMC |
|---|---|
| Author | Wang, Chun‐Li Wu, Victor Chien‐Chia Huang, Yu‐Tung Kuo, Chang‐Fu Chu, Pao‐Hsien Chen, Yu‐Ling Wen, Ming‐Shien Chang, Shang‐Hung |
| Abstract | BackgroundMajor randomized trials assessing non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation generally excluded patients with hemoglobin <10 g/dL. This study evaluated the safety and effectiveness of NOACs in patients with atrial fibrillation and anemia.Methods and ResultsA cohort study based on electronic medical records was conducted from 2010 to 2017 at a multicenter healthcare provider in Taiwan. It included 8356 patients with atrial fibrillation who had received oral anticoagulants (age, 77.0±7.3 years; 48.0% women). Patients were classified into 2 subgroups: 7687 patients with hemoglobin ≥10 g/dL and 669 patients with hemoglobin <10 g/dL. A Cox regression analysis was performed to assess the risks of ischemic stroke/systemic embolism, bleeding, and death associated with NOAC versus warfarin in both subgroups, respectively. In patients with hemoglobin ≥10 g/dL, NOAC (n=4793) was associated with significantly lower risks of ischemic stroke/systemic embolism, major bleeding, and gastrointestinal tract bleeding than warfarin (n=2894); there was no difference in the risk of death. In patients with hemoglobin <10 g/dL, NOAC (n=390) was associated with significantly lower risks of major bleeding (adjusted hazard ratio, 0.43; 95% CI, 0.30–0.62) and gastrointestinal tract bleeding than warfarin (n=279), but there was no difference in the risk of ischemic stroke/systemic embolism (adjusted hazard ratio, 0.79; 95% CI, 0.53–1.17) or death. Subgroup analyses suggested that NOAC was associated with fewer bleeding events, irrespective of cancer or peptic ulcer disease history.ConclusionsIn patients with atrial fibrillation with hemoglobin <10 g/dL, NOAC was associated with lower bleeding risks than warfarin, with no difference in the risk of ischemic stroke/systemic embolism or death. |
| Page Count | 11 |
| Journal | Journal of the American Heart Association |
| Volume Number | 8 |
| PubMed Central reference number | PMC6512084 |
| Issue Number | 9 |
| PubMed reference number | 31020896 |
| e-ISSN | 20479980 |
| DOI | 10.1161/jaha.119.012029 |
| Language | English |
| Publisher | John Wiley and Sons Inc. |
| Publisher Date | 2019-05-01 |
| Publisher Place | Hoboken |
| Access Restriction | Open |
| Rights License | This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. |
| Subject Keyword | anemia anticoagulation atrial fibrillation bleeding outcome Atrial Fibrillation Cerebrovascular Disease/Stroke Anticoagulants |
| Content Type | Text |
| Resource Type | Article |
| Subject | Cardiology and Cardiovascular Medicine |
