Long-term effectiveness and safety of non-vitamin K antagonist anticoagulant in real world practice

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUNDS: Novel oral anticoagulants (NOACs) are effective to prevent stroke in patients with atrial fibrillation. Real world long-term data on the efficacy and safety of NOACs compared to warfarin in Asians are lacking. PURPOSE: We aimed to explore the effectiveness and safety of NOAC in Asian patients with atrial fibrillation. METHODS: The medical records were reviewed in registry of four tertiary referral hospitals between January 1, 2012, and December 31, 2020. The primary outcome was the composite of thromboembolism, major bleeding and all caused mortality. RESULTS: Data were analyzed for 19,994 participants with oral anticoagulant and atrial fibrillation (median age, 72 years; female, 41.5%; warfarin, 35.5%; median CHA2DS2-VASc score, 3). The rate of the primary outcome was 5.5% per year in the NOAC group, as compared with 6.0% per year in the warfarin group (HR with NOAC, 0.70; 95% confidence interval [CI], 0.63 to 0.77; P<0.001 for superiority). The rate of ischemic event was 2.2% per year in the NOAC group, as compared with 2.8% per year in the warfarin group (HR, 0.56; 95% CI, 0.48 to 0.65; P<0.001). The rate of major bleeding was 1.9% per year in the NOAC group, as compared with 2.2% per year in the warfarin group (HR, 0.69; 95% CI, 0.58 to 0.82; P<0.001), and the rates of all caused death were 1.9% and 3.2%, respectively (HR, 0.85; 95% CI, 0.71 to 1.02; P=0.08). CONCLUSION: In Asian patients with atrial fibrillation, NOAC was effective and safe to prevent thromboembolic events with less bleeding compared to warfarin. [Figure: see text]