Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Study Endpoints
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Effectiveness Outcomes
3.3. Safety Outcomes
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Groups | Daily Doses (mg) | ||
---|---|---|---|
Apixaban | Dabigatran | Rivaroxaban | |
Standard dose 1 | 10 | 300 | 20 |
Reduced dose 2 | 5 * | 220 | 15 |
Other dose 3 | <5 or >10 | <220 or >300 | <15 or >20 |
Propensity Score Matching | ||||||
---|---|---|---|---|---|---|
After 1,2 | ||||||
R.Apixaban (n = 4774) | Warfarin (n = 4774) | R.Dabigatran (n = 5221) | Warfarin (n = 5221) | R.Rivaroxaban (n = 5746) | Warfarin (n = 5746) | |
Age (years), mean | 75.50 | 75.45 | 73.94 | 73.85 | 74.21 | 74.15 |
Female, % | 49.37 | 49.73 | 44.38 | 44.86 | 45.04 | 45.41 |
CHA2DS2-VASc, mean | 4.97 | 4.99 | 4.67 | 4.68 | 4.71 | 4.73 |
HAS-BLED, mean | 3.74 | 3.75 | 3.63 | 3.63 | 3.66 | 3.67 |
CCI, mean | 4.55 | 4.55 | 4.18 | 4.20 | 4.29 | 4.33 |
Insurance, % | ||||||
National health insurance | 92.42 | 91.94 | 92.01 | 91.59 | 92.24 | 92.36 |
Medical aid | 7.58 | 8.06 | 7.99 | 8.41 | 7.76 | 7.64 |
Medical history, % | ||||||
Heart failure | 45.35 | 45.92 | 42.56 | 42.56 | 43.84 | 44.43 |
Hypertension | 87.81 | 88.37 | 88.89 | 89.29 | 88.58 | 89.00 |
Diabetes | 56.66 | 57.27 | 53.36 | 53.65 | 54.47 | 55.33 |
Ischemic stroke | 38.04 | 38.77 | 34.09 | 34.17 | 34.08 | 34.16 |
Vascular disease | 32.45 | 31.57 | 31.68 | 31.95 | 32.02 | 32.09 |
Renal disease (CKD3/4) | 3.10 | 3.10 | 1.26 | 1.11 | 2.61 | 2.61 |
Bleeding | 14.62 | 14.73 | 9.84 | 9.83 | 12.63 | 13.00 |
Medication history, % | ||||||
NSAIDs | 80.23 | 79.10 | 79.95 | 80.52 | 79.24 | 79.38 |
Antiplatelets | 75.12 | 75.05 | 74.28 | 74.33 | 75.20 | 75.18 |
Antiarrhythmics | 48.66 | 47.72 | 46.75 | 46.56 | 45.70 | 45.49 |
Statins | 58.59 | 59.70 | 56.22 | 57.04 | 54.72 | 55.46 |
PPI | 46.19 | 45.60 | 43.33 | 43.04 | 44.33 | 43.63 |
H2RA | 70.34 | 69.92 | 68.86 | 68.51 | 68.53 | 68.97 |
Digoxin | 27.34 | 27.17 | 27.93 | 27.70 | 28.30 | 28.70 |
Reduced Dosing | Warfarin (n = 8648) | R.Api (n = 4774) | Warfarin (n = 4774) | R.Dabi (n = 5221) | Warfarin (n = 5221) | R.Riva (n = 5746) | Warfarin (n = 5746) | |||
---|---|---|---|---|---|---|---|---|---|---|
Apixaban (n = 5249) | Dabigatran (n = 6033) | Rivaroxaban (n = 7602) | ||||||||
Crude Event Rates 1 | Event Rates in Matched Cohorts 1 | |||||||||
S/SE | 8.56 | 5.88 | 7.30 | 11.86 | 8.67 | 14.90 | 6.10 | 13.77 | 8.14 | 13.40 |
IS | 7.92 | 5.28 | 6.52 | 10.33 | 8.00 | 12.98 | 5.44 | 11.85 | 7.31 | 11.64 |
HS | 0.97 | 0.64 | 1.04 | 1.52 | 1.02 | 1.93 | 0.72 | 1.84 | 1.21 | 1.89 |
SE | 0.15 | 0.17 | 0.31 | 0.76 | 0.17 | 0.89 | 0.19 | 0.80 | 0.29 | 0.69 |
MB | 8.40 | 7.60 | 9.94 | 13.53 | 8.67 | 16.95 | 7.74 | 14.76 | 10.78 | 15.98 |
ICH | 1.35 | 0.81 | 1.47 | 2.06 | 1.41 | 2.61 | 0.85 | 2.45 | 1.66 | 2.49 |
GI | 3.89 | 4.01 | 4.48 | 5.57 | 3.95 | 7.07 | 4.01 | 6.08 | 4.78 | 6.46 |
Oth | 3.70 | 3.39 | 4.56 | 6.58 | 3.87 | 8.13 | 3.51 | 7.18 | 4.97 | 7.79 |
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Han, S.; Kim, Y.-H.; Lee, M.-Y.; Bang, O.Y.; Jang, S.-W.; Han, S.; Park, Y.-J.; Kang, S.; On, Y.K.; Suh, H.S. Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study. J. Clin. Med. 2021, 10, 3918. https://doi.org/10.3390/jcm10173918
Han S, Kim Y-H, Lee M-Y, Bang OY, Jang S-W, Han S, Park Y-J, Kang S, On YK, Suh HS. Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study. Journal of Clinical Medicine. 2021; 10(17):3918. https://doi.org/10.3390/jcm10173918
Chicago/Turabian StyleHan, Sola, Young-Hoon Kim, Myung-Yong Lee, Oh Young Bang, Sung-Won Jang, Seongwook Han, Yoo-Jung Park, Seongsik Kang, Young Keun On, and Hae Sun Suh. 2021. "Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study" Journal of Clinical Medicine 10, no. 17: 3918. https://doi.org/10.3390/jcm10173918
APA StyleHan, S., Kim, Y.-H., Lee, M.-Y., Bang, O. Y., Jang, S.-W., Han, S., Park, Y.-J., Kang, S., On, Y. K., & Suh, H. S. (2021). Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study. Journal of Clinical Medicine, 10(17), 3918. https://doi.org/10.3390/jcm10173918