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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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Safety outcomes of major bleeding (A), intracranial hemorrhage (B), hemorrhagic stroke (C), and gastrointestinal bleeding (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 2: Safety outcomes of major bleeding (A), intracranial hemorrhage (B), hemorrhagic stroke (C), and gastrointestinal bleeding (D) for the standard-dose non–vitamin K antagonist (VKA) oral anticoagulants (NOACs) vs VKAs. CI indicates confidence interval; and OR, odds ratio.

Mentions: Figure 2 shows the preferential benefit of standard-dose NOACs in safety outcomes in Asian patients. Standard-dose NOACs reduced major bleeding more in Asian than in non-Asian patients (OR, 0.57; 95% CI, 0.44–0.74; P<0.001 for Asian patients; OR, 0.89; 95% CI, 0.76–1.04; P=0.143 for non-Asian patients; P interaction=0.004). ICH was significantly reduced in both with standard-dose NOACs (OR, 0.33; 95% CI, 0.22–0.50; P<0.001 for Asian patients; OR, 0.52; 95% CI, 0.42–0.64; P<0.001 for non-Asian patients; P interaction=0.059). Standard-dose NOACs had a substantial reduction in hemorrhagic stroke, which was more notable in Asian than in non-Asian patients (OR, 0.32; 95% CI, 0.19–0.52; P<0.001 for Asian patients; OR, 0.56; 95% CI, 0.44–0.70; P<0.001 for non-Asian patients; P interaction=0.046) compared with VKAs. Moreover, standard-dose NOACs increased the risk of gastrointestinal bleeding in non-Asian patients but not in Asian patients (OR, 1.44; 95% CI, 1.12–1.85; P=0.005 for non-Asian patients; OR, 0.79; 95% CI, 0.48–1.32; P=0.378 for Asian patients; P interaction=0.041).


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)

Safety outcomes of major bleeding (A), intracranial hemorrhage (B), hemorrhagic stroke (C), and gastrointestinal bleeding (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 2: Safety outcomes of major bleeding (A), intracranial hemorrhage (B), hemorrhagic stroke (C), and gastrointestinal bleeding (D) for the standard-dose non–vitamin K antagonist (VKA) oral anticoagulants (NOACs) vs VKAs. CI indicates confidence interval; and OR, odds ratio.
Mentions: Figure 2 shows the preferential benefit of standard-dose NOACs in safety outcomes in Asian patients. Standard-dose NOACs reduced major bleeding more in Asian than in non-Asian patients (OR, 0.57; 95% CI, 0.44–0.74; P<0.001 for Asian patients; OR, 0.89; 95% CI, 0.76–1.04; P=0.143 for non-Asian patients; P interaction=0.004). ICH was significantly reduced in both with standard-dose NOACs (OR, 0.33; 95% CI, 0.22–0.50; P<0.001 for Asian patients; OR, 0.52; 95% CI, 0.42–0.64; P<0.001 for non-Asian patients; P interaction=0.059). Standard-dose NOACs had a substantial reduction in hemorrhagic stroke, which was more notable in Asian than in non-Asian patients (OR, 0.32; 95% CI, 0.19–0.52; P<0.001 for Asian patients; OR, 0.56; 95% CI, 0.44–0.70; P<0.001 for non-Asian patients; P interaction=0.046) compared with VKAs. Moreover, standard-dose NOACs increased the risk of gastrointestinal bleeding in non-Asian patients but not in Asian patients (OR, 1.44; 95% CI, 1.12–1.85; P=0.005 for non-Asian patients; OR, 0.79; 95% CI, 0.48–1.32; P=0.378 for Asian patients; P interaction=0.041).

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.).

Show MeSH
Related in: MedlinePlus