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Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: A nationwide, population-based study in Korea

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Author(s)
Seongwook HanSola Han PharmDHae Sun SuhOh Young BangYoung Keun OnMyung-Yong LeeSung-Won JangMi-Mi WonYoo-Jung ParkJi-Min LeeSeongsik KangYoung-Hoon Kim
Keimyung Author(s)
Han, Seong Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
J Arrhythm
Issued Date
2021
Volume
37
Issue
5
Keyword
anticoagulantsatrial fibrillationintracranial hemorrhagestrokethromboembolism
Abstract
Background:
To compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) between non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF), this retrospective study was conducted using the Korean Health Insurance Review & Assessment Service (HIRA) claims database.

Methods:
Patients with AF who initiated NOACs (apixaban, dabigatran, and rivaroxaban) from July 1, 2015 to November 30, 2016 were included. We applied inverse probability of treatment weighting (IPTW) method using propensity score to make weighted populations having similar characteristics between groups. Hazard ratio (HR) of S/SE and MB were estimated by Cox proportional hazard model.

Results:
Of the 39 783 patients with AF, 10 564; 11 418; and 17 801 used apixaban, dabigatran, and rivaroxaban, respectively. The mean CHA2DS2-VASc and HAS-BLED scores were 4.59 ~ 4.69 and 3.58 ~ 3.62, respectively, among all patients after applying IPTW. For S/SE, there were no significant differences between NOACs (HR [95% confidence interval (CI)]): apixaban vs dabigatran (0.99 [0.87-1.13]), apixaban vs rivaroxaban (0.95 [0.84-1.07]), and dabigatran vs rivaroxaban (0.96 [0.85-1.08]). For MB (HR [95% CI]), both apixaban (0.77 [0.68-0.86]) and dabigatran (0.88 [0.79-0.98]) had a significantly lower risk compared with rivaroxaban. Apixaban also had a significantly lower risk of MB compared with dabigatran (0.87 [0.76-0.99]).

Conclusions:
In real-world practice among Korean AF patients with relatively high risk of stroke and bleeding, there were no significant differences in the risk of S/SE between all NOAC comparisons. Apixaban was associated with lower risk of MB than dabigatran and rivaroxaban.
Keimyung Author(s)(Kor)
한성욱
Publisher
School of Medicine (의과대학)
Citation
Seongwook Han et al. (2021). Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: A nationwide, population-based study in Korea. J Arrhythm, 37(5), 1240–1249. doi: 10.1002/joa3.12607
Type
Article
ISSN
1883-2148
Source
https://onlinelibrary.wiley.com/doi/10.1002/joa3.12607
DOI
10.1002/joa3.12607
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43958
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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