Cargando…

Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease

Background: There are limited data for non-vitamin K antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) t...

Descripción completa

Detalles Bibliográficos
Autores principales: Moon, Inki, Lee, So-Ryoung, Choi, Eue-Keun, Lee, Euijae, Jung, Jin-Hyung, Han, Kyung-Do, Cha, Myung-Jin, Oh, Seil, Lip, Gregory Y.H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832302/
https://www.ncbi.nlm.nih.gov/pubmed/31590290
http://dx.doi.org/10.3390/jcm8101624
_version_ 1783466139844608000
author Moon, Inki
Lee, So-Ryoung
Choi, Eue-Keun
Lee, Euijae
Jung, Jin-Hyung
Han, Kyung-Do
Cha, Myung-Jin
Oh, Seil
Lip, Gregory Y.H.
author_facet Moon, Inki
Lee, So-Ryoung
Choi, Eue-Keun
Lee, Euijae
Jung, Jin-Hyung
Han, Kyung-Do
Cha, Myung-Jin
Oh, Seil
Lip, Gregory Y.H.
author_sort Moon, Inki
collection PubMed
description Background: There are limited data for non-vitamin K antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naïve from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroke, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroke, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. Results: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risks of ischemic stroke (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53–0.96), GI bleeding (HR: 0.50, 95% CI: 0.35–0.72), fatal ICH (HR: 0.28, 95% CI: 0.07–0.83), and major bleeding (HR: 0.61, 95% CI: 0.45–0.80) compared with warfarin. Overall, NOACs were associated with a lower risk of the composite outcome (HR: 0.68, 95% CI: 0.58–0.80). Conclusions: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risks of ischemic stroke, major bleeding, all-cause death, and the composite outcome compared to warfarin use.
format Online
Article
Text
id pubmed-6832302
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-68323022019-11-21 Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease Moon, Inki Lee, So-Ryoung Choi, Eue-Keun Lee, Euijae Jung, Jin-Hyung Han, Kyung-Do Cha, Myung-Jin Oh, Seil Lip, Gregory Y.H. J Clin Med Article Background: There are limited data for non-vitamin K antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naïve from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroke, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroke, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. Results: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risks of ischemic stroke (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53–0.96), GI bleeding (HR: 0.50, 95% CI: 0.35–0.72), fatal ICH (HR: 0.28, 95% CI: 0.07–0.83), and major bleeding (HR: 0.61, 95% CI: 0.45–0.80) compared with warfarin. Overall, NOACs were associated with a lower risk of the composite outcome (HR: 0.68, 95% CI: 0.58–0.80). Conclusions: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risks of ischemic stroke, major bleeding, all-cause death, and the composite outcome compared to warfarin use. MDPI 2019-10-04 /pmc/articles/PMC6832302/ /pubmed/31590290 http://dx.doi.org/10.3390/jcm8101624 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Moon, Inki
Lee, So-Ryoung
Choi, Eue-Keun
Lee, Euijae
Jung, Jin-Hyung
Han, Kyung-Do
Cha, Myung-Jin
Oh, Seil
Lip, Gregory Y.H.
Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease
title Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease
title_full Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease
title_fullStr Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease
title_full_unstemmed Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease
title_short Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease
title_sort non-vitamin k antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832302/
https://www.ncbi.nlm.nih.gov/pubmed/31590290
http://dx.doi.org/10.3390/jcm8101624
work_keys_str_mv AT mooninki nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT leesoryoung nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT choieuekeun nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT leeeuijae nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT jungjinhyung nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT hankyungdo nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT chamyungjin nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT ohseil nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease
AT lipgregoryyh nonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationandvalvularheartdisease