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Background: Bleeding or thromboembolism prevention is important in patients with atrial fibrillation receiving anticoagulants, including non-vitamin K oral anticoagulants and warfarin. Asians have higher risks of bleeding complications when taking anticoagulants. However, evidence that considers laboratory parameters is lacking.
Objective: We aimed to compare the safety and effectiveness between non-vitamin K oral anticoagulants and warfarin in Asian patients with atrial fibrillation.
Setting: Retrospective design using hospital-based data.
Method: This propensity score-matched cohort study included data extracted from the electronic medical records of the En Chu Kong Hospital Research Database.
Main outcome measure: Outcome measures were major bleeding and thromboembolism. Cox proportional hazard models were applied for evaluating hazard ratios with 95% confidence intervals.
Results: Among 1,075 patients with atrial fibrillation, 687 and 388 were administered non-vitamin K oral anticoagulants and warfarin, respectively. After propensity score matching, 264 patient pairs were selected. Compared with warfarin use, non-vitamin K oral anticoagulant use was associated with similar risks for major bleeding and thromboembolism; however, the latter was associated with increased gastrointestinal bleeding risks (adjusted hazard ratio 3.59; 95% confidence interval, 1.31-11.39). Notably, an approximately 10-fold increased risk of gastrointestinal bleeding was observed in 0-6-month non-vitamin K oral anticoagulant users (adjusted hazard ratio 10.13, 95% confidence interval 1.27-80.89).
Conclusion: Non-vitamin K oral anticoagulant use was not associated with major bleeding and thromboembolism occurrence in Asian patients with atrial fibrillation. However, non-vitamin K oral anticoagulant use was associated with increased gastrointestinal bleeding risks, especially when used within 0-6 months.
Keywords
warfarin, non-vitamin K oral anticoagulants, Asian patients, bleeding, thromboembolism
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View the published article at International Journal of Clinical Pharmacy.
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Posted 11 May, 2021
No community comments so far
Reviewers invited
Invitations sent on 10 May, 2021
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Received 09 May, 2021
Editor invited
On 07 May, 2021
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On 05 May, 2021
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On 05 May, 2021
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Subject Areas
Clinical Pharmacology
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A new preprint design is coming!
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See the published version of this preprint at International Journal of Clinical Pharmacy.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at International Journal of Clinical Pharmacy.
Version 1
Posted 11 May, 2021
No community comments so far
Reviewers invited
Invitations sent on 10 May, 2021
Reviews received
Received 09 May, 2021
Editor invited
On 07 May, 2021
Editor assigned
On 05 May, 2021
First submitted
On 05 May, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Clinical Pharmacology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at International Journal of Clinical Pharmacy.
Background: Bleeding or thromboembolism prevention is important in patients with atrial fibrillation receiving anticoagulants, including non-vitamin K oral anticoagulants and warfarin. Asians have higher risks of bleeding complications when taking anticoagulants. However, evidence that considers laboratory parameters is lacking.
Objective: We aimed to compare the safety and effectiveness between non-vitamin K oral anticoagulants and warfarin in Asian patients with atrial fibrillation.
Setting: Retrospective design using hospital-based data.
Method: This propensity score-matched cohort study included data extracted from the electronic medical records of the En Chu Kong Hospital Research Database.
Main outcome measure: Outcome measures were major bleeding and thromboembolism. Cox proportional hazard models were applied for evaluating hazard ratios with 95% confidence intervals.
Results: Among 1,075 patients with atrial fibrillation, 687 and 388 were administered non-vitamin K oral anticoagulants and warfarin, respectively. After propensity score matching, 264 patient pairs were selected. Compared with warfarin use, non-vitamin K oral anticoagulant use was associated with similar risks for major bleeding and thromboembolism; however, the latter was associated with increased gastrointestinal bleeding risks (adjusted hazard ratio 3.59; 95% confidence interval, 1.31-11.39). Notably, an approximately 10-fold increased risk of gastrointestinal bleeding was observed in 0-6-month non-vitamin K oral anticoagulant users (adjusted hazard ratio 10.13, 95% confidence interval 1.27-80.89).
Conclusion: Non-vitamin K oral anticoagulant use was not associated with major bleeding and thromboembolism occurrence in Asian patients with atrial fibrillation. However, non-vitamin K oral anticoagulant use was associated with increased gastrointestinal bleeding risks, especially when used within 0-6 months.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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