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Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation: Meta-Analysis.

Wang KL, Lip GY, Lin SJ, Chiang CE - Stroke (2015)

Bottom Line: Comparing with VKAs, standard-dose NOACs reduced stroke or systemic embolism (OR=0.65 [0.52-0.83] versus 0.85 [0.77-0.93], P interaction= 0.045) more in Asians than in non-Asians and were safer in Asians than in non-Asians about major bleeding (OR=0.57 [0.44-0.74] versus 0.89 [0.76-1.04], P interaction=0.004), hemorrhagic stroke (OR=0.32 [0.19-0.52] versus 0.56 [0.44-0.70], P interaction=0.046) in particular, whereas gastrointestinal bleeding was significantly increased in non-Asians (OR=0.79 [0.48-1.32] versus 1.44 [1.12-1.85], P interaction=0.041).Generally, low-dose NOACs were safer than VKAs without heterogeneity in efficacy and safety between Asians and non-Asians, except for ischemic stroke, major, and gastrointestinal bleeding.Our findings suggest that standard-dose NOACs were more effective and safer in Asians than in non-Asians, whereas low-dose NOACs performed similarly in both populations.

View Article: PubMed Central - PubMed

Affiliation: From the General Clinical Research Center (K.-L.W., C.-E.C.), Department of Medical Research (K.-L.W., S.-J.L., C.-E.C.), and Division of Cardiology (K.-L.W., S.-J.L., C.-E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan (K.-L.W., S.-J.L., C.-E.C.); University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).

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Efficacy outcomes of stroke or systemic embolism (A), ischemic stroke (B), myocardial infarction (C), and all-cause mortality (D) for the standard-dose non–vitamin K antagonist (VKA) oral anticoagulants (NOACs) vs VKAs. CI indicates confidence interval; and OR, odds ratio.
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Figure 1: Efficacy outcomes of stroke or systemic embolism (A), ischemic stroke (B), myocardial infarction (C), and all-cause mortality (D) for the standard-dose non–vitamin K antagonist (VKA) oral anticoagulants (NOACs) vs VKAs. CI indicates confidence interval; and OR, odds ratio.

Mentions: The comparative efficacy of standard-dose NOACs and VKAs is presented in Figure 1. Standard-dose NOACs significantly reduced the composite of stroke or systemic embolism both in Asian and non-Asian patients (OR, 0.65; 95% CI, 0.52–0.83; P<0.001 for Asian patients; OR, 0.85; 95% CI, 0.77–0.93; P<0.001 for non-Asian patients). The reduction was more prominent in Asian patients than in non-Asian patients (P interaction=0.045). The effect of standard-dose NOACs on ischemic stroke and myocardial infarction was comparable with VKAs in both Asian and non-Asian patients (P interaction=0.673 and 0.977, respectively). All-cause mortality was significantly lower in both with standard-dose NOACs than with VKAs (OR, 0.80; 95% CI, 0.65–0.98; P=0.030 for Asian patients; OR, 0.91; 95% CI, 0.86–0.97; P=0.003 for non-Asian patients; P interaction=0.219).


Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation: Meta-Analysis.

Wang KL, Lip GY, Lin SJ, Chiang CE - Stroke (2015)

Efficacy outcomes of stroke or systemic embolism (A), ischemic stroke (B), myocardial infarction (C), and all-cause mortality (D) for the standard-dose non–vitamin K antagonist (VKA) oral anticoagulants (NOACs) vs VKAs. CI indicates confidence interval; and OR, odds ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4542566&req=5

Figure 1: Efficacy outcomes of stroke or systemic embolism (A), ischemic stroke (B), myocardial infarction (C), and all-cause mortality (D) for the standard-dose non–vitamin K antagonist (VKA) oral anticoagulants (NOACs) vs VKAs. CI indicates confidence interval; and OR, odds ratio.
Mentions: The comparative efficacy of standard-dose NOACs and VKAs is presented in Figure 1. Standard-dose NOACs significantly reduced the composite of stroke or systemic embolism both in Asian and non-Asian patients (OR, 0.65; 95% CI, 0.52–0.83; P<0.001 for Asian patients; OR, 0.85; 95% CI, 0.77–0.93; P<0.001 for non-Asian patients). The reduction was more prominent in Asian patients than in non-Asian patients (P interaction=0.045). The effect of standard-dose NOACs on ischemic stroke and myocardial infarction was comparable with VKAs in both Asian and non-Asian patients (P interaction=0.673 and 0.977, respectively). All-cause mortality was significantly lower in both with standard-dose NOACs than with VKAs (OR, 0.80; 95% CI, 0.65–0.98; P=0.030 for Asian patients; OR, 0.91; 95% CI, 0.86–0.97; P=0.003 for non-Asian patients; P interaction=0.219).

Bottom Line: Comparing with VKAs, standard-dose NOACs reduced stroke or systemic embolism (OR=0.65 [0.52-0.83] versus 0.85 [0.77-0.93], P interaction= 0.045) more in Asians than in non-Asians and were safer in Asians than in non-Asians about major bleeding (OR=0.57 [0.44-0.74] versus 0.89 [0.76-1.04], P interaction=0.004), hemorrhagic stroke (OR=0.32 [0.19-0.52] versus 0.56 [0.44-0.70], P interaction=0.046) in particular, whereas gastrointestinal bleeding was significantly increased in non-Asians (OR=0.79 [0.48-1.32] versus 1.44 [1.12-1.85], P interaction=0.041).Generally, low-dose NOACs were safer than VKAs without heterogeneity in efficacy and safety between Asians and non-Asians, except for ischemic stroke, major, and gastrointestinal bleeding.Our findings suggest that standard-dose NOACs were more effective and safer in Asians than in non-Asians, whereas low-dose NOACs performed similarly in both populations.

View Article: PubMed Central - PubMed

Affiliation: From the General Clinical Research Center (K.-L.W., C.-E.C.), Department of Medical Research (K.-L.W., S.-J.L., C.-E.C.), and Division of Cardiology (K.-L.W., S.-J.L., C.-E.C.), Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan (K.-L.W., S.-J.L., C.-E.C.); University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).

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Related in: MedlinePlus