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Safety and efficacy of non–vitamin K antagonist oral anticoagulants compared with well-controlled warfarin in Thai patients with atrial fibrillation

Janekij Yamkasikorn
Janekij Yamkasikorn
 und 
Komsing Methavigul
Komsing Methavigul
   | 30. Juni 2022
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Article Category: Brief communication (original)
Online veröffentlicht: 30. Juni 2022
Seitenbereich: 131 - 136
DOI: https://doi.org/10.2478/abm-2022-0016
Schlüsselwörter
© 2022 Janekij Yamkasikorn et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Comparison of total bleeding or thromboembolic events or both (A), thromboembolic events (B), major bleeding (C), and minor bleeding (D) between 90 patients with AF who received NOACs and 90 patients with AF who received well-controlled warfarin (TTR > 65%) treatment. Black bars indicate the presence of events, and gray bars indicate the absence of events. AF, atrial fibrillation; TTR, time in the therapeutic range; NOACs; non–vitamin K antagonist oral anticoagulants.
Comparison of total bleeding or thromboembolic events or both (A), thromboembolic events (B), major bleeding (C), and minor bleeding (D) between 90 patients with AF who received NOACs and 90 patients with AF who received well-controlled warfarin (TTR > 65%) treatment. Black bars indicate the presence of events, and gray bars indicate the absence of events. AF, atrial fibrillation; TTR, time in the therapeutic range; NOACs; non–vitamin K antagonist oral anticoagulants.

Primary and secondary outcomes of NOAC and well-controlled warfarin treatment in patients with AF

Outcomes Warfarin (n = 90) n (%) NOACs (n = 90) n (%) OR (95% CI) P
Primary outcome: total bleeding or thromboembolic events or both 19 (21) 7 (8) 3.17 (2.27–4.07) 0.01*
Secondary outcome
Thromboembolic events or major bleeding or both 1 (1) 1 (1) 1.00 (−1.78 to 3.78) >0.99
Thromboembolic events 0 (0) 1 (1) – –
Major bleeding 1 (1) 0 (0) – –
Minor bleeding 19 (21) 6 (7) 3.75 (2.79–4.71) 0.01*
  Bleeding per gum 2 (2) 1 (1) 2.02 (−0.40 to 4.44) >0.99
  Bruising 12 (13) 5 (6) 2.61 (1.53–3.69) 0.047
  Hematuria 3 (3) 2 (2) 1.51 (−0.29 to 3.31) >0.99
  Epistaxis 1 (1) 0 (0) – –
  Subconjunctival hemorrhage 2 (2) 0 (0) – –
All-cause mortality 0 (0) 0 (0) – –

Baseline characteristics of Thai patients with AF

Demographic data Total (n = 180) n (%) Warfarin (n = 90) n (%) NOACs (n = 90) n (%) P
Age (years), mean ± SD 72.8 ± 10.1 71.3 ± 10.2 74.3 ± 9.8 0.04*
Male sex 107 (59) 48 (53) 59 (66) 0.10
Medical welfare
  Affiliation reimbursement 122 (68) 40 (44) 82 (91) <0.01*
  Universal healthcare coverage 43 (24) 40 (44) 3 (3)
  Social security scheme 3 (2) 3 (3) 0 (0)
  Self-payment 12 (7) 7 (8) 5 (6)
Medical history
  Diabetes 50 (28) 23 (26) 27 (30) 0.51
  Hypertension 162 (90) 79 (88) 83 (92) 0.32
  Dyslipidemia 139 (77) 69 (77) 70 (78) 0.86
  Coronary artery disease 36 (20) 14 (16) 22 (24) 0.14
  Peripheral artery disease 0 (0) 0 (0) 0 (0) –
  Previous myocardial infarction 24 (13) 13 (14) 11 (12) 0.66
  Previous ischemic stroke or TIA 34 (19) 14 (16) 20 (22) 0.25
  History of intracranial bleeding 2 (1) 0 (0) 2 (2) 0.50
  History of heart failure 74 (41) 43 (48) 31 (34) 0.07
  Cirrhosis 1 (1) 0 (0) 1 (1) –
  Chronic kidney disease 54 (30) 28 (31) 26 (29) 0.78
Smoking, n (%) 48 (28) 23 (26) 25 (29) 0.66
eGFR (mL/min/1.73 m2), median (IQR) 70.75 (58.0, 85.8) 70.72 (57.3, 85.1) 70.75 (58.2, 87.0) 0.87
CHA2 DS2-VASc score, median (IQR) 4 (3, 5) 4 (3, 5) 4 (3, 5.3) 0.30
HAS-BLED score, median (IQR) 2 (1, 2) 1 (1, 2) 2 (1, 2) <0.01*
SAMeTT2 R2 score, median (IQR) 4 (3, 4) 4 (3, 4) 4 (3, 4) 0.70
  0–2 15 (9) 7 (8) 8 (9) 0.75
  ≥3 157 (91) 80 (92) 77 (91)
Time in the therapeutic range (%), mean ± SD 84.9 ± 9.8 – –
Antiplatelets 10 (6) 7 (8) 3 (3)
  Aspirin 3 (2) 2 (2) 1 (1) –
  P2Y12 inhibitors 7 (4) 5 (6) 2 (2) 0.44
OAC
  Warfarin 90 (100) – –
  Rivaroxaban – 30 (33) –
  Apixaban – 26 (29) –
  Dabigatran – 17 (19) –
  Edoxaban – 17 (19) –
NSAIDs 6 (3) 0 (0) 6 (7) 0.03*
Proton pump inhibitors 51 (28) 23 (26) 28 (31) 0.41
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