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Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation
We investigated the effectiveness and safety of direct oral anticoagulants (DOACs) for secondary prevention in patients with atrial fibrillation (AF), particularly focusing on subgroups of patients with severe, disabling, and recent stroke. Using the Korean National Health Insurance Service claims d...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947173/ https://www.ncbi.nlm.nih.gov/pubmed/31861095 http://dx.doi.org/10.3390/jcm8122228 |
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author | Park, Jiesuck Lee, So-Ryoung Choi, Eue-Keun Kwon, Soonil Jung, Jin-Hyung Han, Kyung-Do Cha, Myung-Jin Ko, Sang-Bae Oh, Seil Lip, Gregory Y. H. |
author_facet | Park, Jiesuck Lee, So-Ryoung Choi, Eue-Keun Kwon, Soonil Jung, Jin-Hyung Han, Kyung-Do Cha, Myung-Jin Ko, Sang-Bae Oh, Seil Lip, Gregory Y. H. |
author_sort | Park, Jiesuck |
collection | PubMed |
description | We investigated the effectiveness and safety of direct oral anticoagulants (DOACs) for secondary prevention in patients with atrial fibrillation (AF), particularly focusing on subgroups of patients with severe, disabling, and recent stroke. Using the Korean National Health Insurance Service claims database between January 2010 and April 2018, we selected OAC-naïve patients with non-valvular AF and a history of stroke. Cumulative risks for recurrent stroke, major bleeding, composite outcome (recurrent stroke + major bleeding), and mortality were compared between DOAC and warfarin groups. Among 61,568 patients, 28,839 and 32,729 received warfarin and DOACs, respectively. Compared with warfarin, DOACs were associated with lower risks of recurrent stroke (hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.62–0.72), major bleeding (HR 0.73, 95% CI 0.66–0.80), composite outcome (HR 0.69, 95% CI 0.65–0.73), and mortality. DOAC use resulted in a consistent trend of improved outcomes in the subgroups of patients with severe, disabling, and recent stroke. In conclusion, DOACs were associated with lower risks of recurrent stroke, major bleeding, composite clinical outcomes, and mortality in patients with AF and a history of stroke. These results were consistent across all types of DOACs and subgroups of patients with severe, disabling, and recent stroke. |
format | Online Article Text |
id | pubmed-6947173 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-69471732020-01-13 Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation Park, Jiesuck Lee, So-Ryoung Choi, Eue-Keun Kwon, Soonil Jung, Jin-Hyung Han, Kyung-Do Cha, Myung-Jin Ko, Sang-Bae Oh, Seil Lip, Gregory Y. H. J Clin Med Article We investigated the effectiveness and safety of direct oral anticoagulants (DOACs) for secondary prevention in patients with atrial fibrillation (AF), particularly focusing on subgroups of patients with severe, disabling, and recent stroke. Using the Korean National Health Insurance Service claims database between January 2010 and April 2018, we selected OAC-naïve patients with non-valvular AF and a history of stroke. Cumulative risks for recurrent stroke, major bleeding, composite outcome (recurrent stroke + major bleeding), and mortality were compared between DOAC and warfarin groups. Among 61,568 patients, 28,839 and 32,729 received warfarin and DOACs, respectively. Compared with warfarin, DOACs were associated with lower risks of recurrent stroke (hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.62–0.72), major bleeding (HR 0.73, 95% CI 0.66–0.80), composite outcome (HR 0.69, 95% CI 0.65–0.73), and mortality. DOAC use resulted in a consistent trend of improved outcomes in the subgroups of patients with severe, disabling, and recent stroke. In conclusion, DOACs were associated with lower risks of recurrent stroke, major bleeding, composite clinical outcomes, and mortality in patients with AF and a history of stroke. These results were consistent across all types of DOACs and subgroups of patients with severe, disabling, and recent stroke. MDPI 2019-12-17 /pmc/articles/PMC6947173/ /pubmed/31861095 http://dx.doi.org/10.3390/jcm8122228 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 Park, Jiesuck Lee, So-Ryoung Choi, Eue-Keun Kwon, Soonil Jung, Jin-Hyung Han, Kyung-Do Cha, Myung-Jin Ko, Sang-Bae Oh, Seil Lip, Gregory Y. H. Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation |
title | Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation |
title_full | Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation |
title_fullStr | Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation |
title_full_unstemmed | Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation |
title_short | Effectiveness and Safety of Direct Oral Anticoagulant for Secondary Prevention in Asians with Atrial Fibrillation |
title_sort | effectiveness and safety of direct oral anticoagulant for secondary prevention in asians with atrial fibrillation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947173/ https://www.ncbi.nlm.nih.gov/pubmed/31861095 http://dx.doi.org/10.3390/jcm8122228 |
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