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Gregory Y H Lip - One of the best experts on this subject based on the ideXlab platform.
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Mortality associated with the use of non‐Vitamin K Antagonist oral anticoagulants in cancer patients: Dabigatran versus rivaroxaban
'Wiley', 2021Co-Authors: Yu‐sheng Lin, Feng‐che Kuan, Tze‐fan Chao, Shao‐wei Chen, Mien‐cheng Chen, Chang‐ming Chung, Pao‐hsien Chu, Gregory Y H LipAbstract:Abstract Objective This study assesses the mortality outcomes of non‐Vitamin K Antagonist oral anticoagulants (NOACs) in cancer patients with venous thromboembolism (VTE) and atrial fibrillation (AF). Methods Medical records of cancer patients receiving NOACs for VTE or AF between January 1, 2011, and December 31, 2016, were retrieved from Taiwan's National Health Institute Research Database. NOACs were compared using the inverse probability of treatment weighting (IPTW) method. The primary outcome was cancer‐related death. Secondary outcomes were all‐cause mortality, major bleeding, and gastrointestinal (GI) bleeding. Results Among 202,754 patients who received anticoagulants, 3591 patients (dabigatran: 907; rivaroxaban: 2684) with active cancers were studied. Patients who received dabigatran were associated with lower risKs of cancer‐related death at one year (HR = 0.71, 95% CI = 0.54–0.93) and at the end of follow‐ups (HR = 0.79, 95% CI = 0.64–0.98) compared with rivaroxaban. Patients who received dabigatran were also associated with lower risKs of all‐cause mortality (HR = 0.81, 95% CI = 0.67–0.97), major bleeding (HR = 0.64, 95% CI = 0.47–0.88), and GI bleeding (HR = 0.57, 95% CI = 0.39–0.84) at the end of follow‐ups compared with rivaroxaban. Conclusion Compared with rivaroxaban, the use of dabigatran may be associated with a lower risK of cancer‐related death and all‐cause mortality
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Practice-derived data on non-Vitamin K Antagonist oral anticoagulant therapy to complement observations from randomized trials.
'Oxford University Press (OUP)', 2020Co-Authors: Domek Magdalena, Gregory Y H Lip, Gumprecht Jakub, Ding, Wern Yew, Lane, Deirdre AAbstract:Anticoagulation is fundamental in the management of patients with atrial fibrillation (AF). The study aims to provide a comparative review of the major phase III randomized clinical trials (RCTs) and real-world data (RWD) from reliable, high-grade Phase IV studies that assess the efficacy and safety of non-Vitamin K Antagonist oral anticoagulants (NOACs) vs. Vitamin K Antagonists (VKAs). Observational studies based on nationwide or health insurance database records on the use of NOACs vs. VKAs in patients with AF were included. We performed a comparison of the efficacy and safety characteristics associated with NOACs vs. VKAs in RCTs and RWD. Although RCTs provide strong support for evidence-based practice, RWD may be used to reflect the broader picture of various clinical settings, provide supplementary insight and fulfil Knowledge gaps. Both study types confirmed the safety and efficacy of NOACs in preventing stroKe and thromboembolism in patients with AF. In comparison to VKAs, NOACs were associated with reduced risK of ischaemic events and lower rates of adverse events such as major bleeding or intracranial haemorrhage. Administration of NOACs might be associated with increased risK of dose-related gastrointestinal bleeding and myocardial ischaemic events, especially in the early treatment period after switching from VKAs. Special care should be taKen in challenging clinical situations liKe severe renal or hepatic impairment when the treatment regimen needs to be considered individually. Randomized clinical trial and RWD studies are complementary and present comparable findings, affirming that NOACs are safe and effective for anticoagulation of patients with AF in daily clinical practice
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Off-label dosing of non-Vitamin K Antagonist oral anticoagulants and clinical outcomes in Asian patients with atrial fibrillation.
'Elsevier BV', 2020Co-Authors: Chan Yi-hsin, Gregory Y H Lip, Chao Tze-fan, Chen Shao-wei, Lee Hsin-fu, Yeh Yung-hsin, Huang Ya-chi, Chang Shang-hung, Kuo Chi-tai, Chen Shih-annAbstract:BACKGROUND:Off-label dosing non-Vitamin K Antagonist oral anticoagulants (NOACs) are commonly prescribed for Asian patients with atrial fibrillation (AF). OBJECTIVE:The purpose of this study was to investigate the associations between inappropriate dosing of NOACs and clinical outcomes. METHODS:We used medical data from a multicenter health care system in Taiwan, which included 2068, 5135, 2589, 1483, and 2342 AF patients taKing dabigatran, rivaroxaban, apixaban, edoxaban, and warfarin, respectively. The risKs of ischemic stroKe/systemic embolism (IS/SE) and major bleeding in patients treated with underdosing or overdosing NOACs were compared to those of on-label dosing NOACs and warfarin. RESULTS:About 27% and 5% of AF patients were treated with underdosing and overdosing NOACs, respectively. Compared to on-label dosing, underdosing NOACs were associated with a significantly higher risK of IS/SE (adjusted hazard ratio [aHR] 1.59; 95% confidence interval [CI] 1.25-2.02; P
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non Vitamin K Antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease
Journal of Clinical Medicine, 2019Co-Authors: Inki Moon, Gregory Y H Lip, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Euijae LeeAbstract:BacKground: There are limited data for non-Vitamin K Antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naive from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroKe, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroKe, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. Results: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risKs of ischemic stroKe (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53–0.96), GI bleeding (HR: 0.50, 95% CI: 0.35–0.72), fatal ICH (HR: 0.28, 95% CI: 0.07–0.83), and major bleeding (HR: 0.61, 95% CI: 0.45–0.80) compared with warfarin. Overall, NOACs were associated with a lower risK of the composite outcome (HR: 0.68, 95% CI: 0.58–0.80). Conclusions: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risKs of ischemic stroKe, major bleeding, all-cause death, and the composite outcome compared to warfarin use.
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Non-Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Supranormal Renal Function
Stroke, 2019Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Gregory Y H LipAbstract:BacKground and Purpose— In clinical trials, the reduced efficacy of non–Vitamin K Antagonist oral anticoagulants (NOACs) for stroKe prevention was reported for patients with nonvalvular atrial fibr...
So Ryoung Lee - One of the best experts on this subject based on the ideXlab platform.
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non Vitamin K Antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease
Journal of Clinical Medicine, 2019Co-Authors: Inki Moon, Gregory Y H Lip, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Euijae LeeAbstract:BacKground: There are limited data for non-Vitamin K Antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naive from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroKe, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroKe, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. Results: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risKs of ischemic stroKe (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53–0.96), GI bleeding (HR: 0.50, 95% CI: 0.35–0.72), fatal ICH (HR: 0.28, 95% CI: 0.07–0.83), and major bleeding (HR: 0.61, 95% CI: 0.45–0.80) compared with warfarin. Overall, NOACs were associated with a lower risK of the composite outcome (HR: 0.68, 95% CI: 0.58–0.80). Conclusions: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risKs of ischemic stroKe, major bleeding, all-cause death, and the composite outcome compared to warfarin use.
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Non-Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Supranormal Renal Function
Stroke, 2019Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Gregory Y H LipAbstract:BacKground and Purpose— In clinical trials, the reduced efficacy of non–Vitamin K Antagonist oral anticoagulants (NOACs) for stroKe prevention was reported for patients with nonvalvular atrial fibr...
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temporal trends of antithrombotic therapy for stroKe prevention in Korean patients with non valvular atrial fibrillation in the era of non Vitamin K Antagonist oral anticoagulants a nationwide population based study
PLOS ONE, 2017Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Gregory Y H LipAbstract:BACKGROUND Following their introduction, the non-Vitamin K Antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroKe prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs. METHODS AND RESULTS Using the National Health Insurance Service database of the entire Korean adult AF population, the use of aspirin, Vitamin K Antagonist, and NOACs between 2008 and 2015 were analyzed (n = 276,246 in 2015). Most of the included cohort had CHA2DS2-VASc score ≥ 2 (78.2% in 2008 and 83.2% in 2015), yet approximately 17% were prescribed no antithrombotic therapy throughout the study period. Aspirin prescription consistently decreased (from 48.2% to 31.5%) over time, while OAC prescription significantly increased from 34.7% to 50.6%. NOAC prescriptions accounted for 50% of total OAC prescription in 2015. Similar trends in antithrombotic therapy were found both in men and in women, but women were more liKely to be undertreated with OAC. Female gender, presence of vascular disease and prior intracranial hemorrhage were associated with OAC underuse. CONCLUSIONS Between 2008 and 2015, a greater proportion of AF patients received OAC treatment with increasing NOAC prescription trends in the recent 3 years. A substantial proportion (approx. 50%) of Korean patients with AF still remain undertreated.
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effectiveness and safety of non Vitamin K Antagonist oral anticoagulants in asian patients with atrial fibrillation
Stroke, 2017Co-Authors: Myung Jin Cha, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Woo Hyun Lim, Gregory Y H LipAbstract:BacKground and Purpose— There are limited real-world data comparing the effectiveness and safety of non-Vitamin K Antagonist oral anticoagulants (NOACs) and warfarin in Asians with nonvalvular atrial fibrillation. We aimed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population, with particular focus on high-risK patients. Methods— Using the Korean National Health Insurance Service database, we analyzed the risK of ischemic stroKe, intracranial hemorrhage (ICH) events, and all-cause death in NOAC users (n=11 611 total, n=5681 taKing rivaroxaban, n=3741 taKing dabigatran, and n=2189 taKing apixaban) compared with propensity score-matched warfarin users (n=23 222) among patients with high-risK atrial fibrillation (CHA 2 DS 2 -VASc score ≥2) between 2014 and 2015. Results— NOAC treatment was associated with similar risK of ischemic stroKe and lower risK of ICH and all-cause mortality compared with warfarin. All 3 NOACs were associated with a similar risK of ischemic stroKe and a lower risK of ICH compared with warfarin. Dabigatran and apixaban were associated with a lower risK of total mortality and the composite net clinical outcome (ischemic stroKe, ICH, and all-cause death) compared with warfarin, whereas this was nonsignificant for rivaroxaban. Among previously oral anticoagulant–naive patients (n=23 262), dabigatran and apixaban were superior to warfarin for ICH prevention, whereas rivaroxaban and warfarin were associated with similar risK of ICH. Conclusions— In real-world practice among a high-risK Asian atrial fibrillation population, all 3 NOACs demonstrated similar risK of ischemic stroKe and lower risK of ICH compared with warfarin. All-cause mortality was significantly lower only with dabigatran and apixaban.
Myung Jin Cha - One of the best experts on this subject based on the ideXlab platform.
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non Vitamin K Antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease
Journal of Clinical Medicine, 2019Co-Authors: Inki Moon, Gregory Y H Lip, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Euijae LeeAbstract:BacKground: There are limited data for non-Vitamin K Antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naive from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroKe, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroKe, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. Results: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risKs of ischemic stroKe (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53–0.96), GI bleeding (HR: 0.50, 95% CI: 0.35–0.72), fatal ICH (HR: 0.28, 95% CI: 0.07–0.83), and major bleeding (HR: 0.61, 95% CI: 0.45–0.80) compared with warfarin. Overall, NOACs were associated with a lower risK of the composite outcome (HR: 0.68, 95% CI: 0.58–0.80). Conclusions: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risKs of ischemic stroKe, major bleeding, all-cause death, and the composite outcome compared to warfarin use.
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Non-Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Supranormal Renal Function
Stroke, 2019Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Gregory Y H LipAbstract:BacKground and Purpose— In clinical trials, the reduced efficacy of non–Vitamin K Antagonist oral anticoagulants (NOACs) for stroKe prevention was reported for patients with nonvalvular atrial fibr...
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temporal trends of antithrombotic therapy for stroKe prevention in Korean patients with non valvular atrial fibrillation in the era of non Vitamin K Antagonist oral anticoagulants a nationwide population based study
PLOS ONE, 2017Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Gregory Y H LipAbstract:BACKGROUND Following their introduction, the non-Vitamin K Antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroKe prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs. METHODS AND RESULTS Using the National Health Insurance Service database of the entire Korean adult AF population, the use of aspirin, Vitamin K Antagonist, and NOACs between 2008 and 2015 were analyzed (n = 276,246 in 2015). Most of the included cohort had CHA2DS2-VASc score ≥ 2 (78.2% in 2008 and 83.2% in 2015), yet approximately 17% were prescribed no antithrombotic therapy throughout the study period. Aspirin prescription consistently decreased (from 48.2% to 31.5%) over time, while OAC prescription significantly increased from 34.7% to 50.6%. NOAC prescriptions accounted for 50% of total OAC prescription in 2015. Similar trends in antithrombotic therapy were found both in men and in women, but women were more liKely to be undertreated with OAC. Female gender, presence of vascular disease and prior intracranial hemorrhage were associated with OAC underuse. CONCLUSIONS Between 2008 and 2015, a greater proportion of AF patients received OAC treatment with increasing NOAC prescription trends in the recent 3 years. A substantial proportion (approx. 50%) of Korean patients with AF still remain undertreated.
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effectiveness and safety of non Vitamin K Antagonist oral anticoagulants in asian patients with atrial fibrillation
Stroke, 2017Co-Authors: Myung Jin Cha, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Woo Hyun Lim, Gregory Y H LipAbstract:BacKground and Purpose— There are limited real-world data comparing the effectiveness and safety of non-Vitamin K Antagonist oral anticoagulants (NOACs) and warfarin in Asians with nonvalvular atrial fibrillation. We aimed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population, with particular focus on high-risK patients. Methods— Using the Korean National Health Insurance Service database, we analyzed the risK of ischemic stroKe, intracranial hemorrhage (ICH) events, and all-cause death in NOAC users (n=11 611 total, n=5681 taKing rivaroxaban, n=3741 taKing dabigatran, and n=2189 taKing apixaban) compared with propensity score-matched warfarin users (n=23 222) among patients with high-risK atrial fibrillation (CHA 2 DS 2 -VASc score ≥2) between 2014 and 2015. Results— NOAC treatment was associated with similar risK of ischemic stroKe and lower risK of ICH and all-cause mortality compared with warfarin. All 3 NOACs were associated with a similar risK of ischemic stroKe and a lower risK of ICH compared with warfarin. Dabigatran and apixaban were associated with a lower risK of total mortality and the composite net clinical outcome (ischemic stroKe, ICH, and all-cause death) compared with warfarin, whereas this was nonsignificant for rivaroxaban. Among previously oral anticoagulant–naive patients (n=23 262), dabigatran and apixaban were superior to warfarin for ICH prevention, whereas rivaroxaban and warfarin were associated with similar risK of ICH. Conclusions— In real-world practice among a high-risK Asian atrial fibrillation population, all 3 NOACs demonstrated similar risK of ischemic stroKe and lower risK of ICH compared with warfarin. All-cause mortality was significantly lower only with dabigatran and apixaban.
Eue Keun Choi - One of the best experts on this subject based on the ideXlab platform.
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non Vitamin K Antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease
Journal of Clinical Medicine, 2019Co-Authors: Inki Moon, Gregory Y H Lip, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Euijae LeeAbstract:BacKground: There are limited data for non-Vitamin K Antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naive from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroKe, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroKe, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. Results: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risKs of ischemic stroKe (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53–0.96), GI bleeding (HR: 0.50, 95% CI: 0.35–0.72), fatal ICH (HR: 0.28, 95% CI: 0.07–0.83), and major bleeding (HR: 0.61, 95% CI: 0.45–0.80) compared with warfarin. Overall, NOACs were associated with a lower risK of the composite outcome (HR: 0.68, 95% CI: 0.58–0.80). Conclusions: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risKs of ischemic stroKe, major bleeding, all-cause death, and the composite outcome compared to warfarin use.
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Non-Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Supranormal Renal Function
Stroke, 2019Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Gregory Y H LipAbstract:BacKground and Purpose— In clinical trials, the reduced efficacy of non–Vitamin K Antagonist oral anticoagulants (NOACs) for stroKe prevention was reported for patients with nonvalvular atrial fibr...
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temporal trends of antithrombotic therapy for stroKe prevention in Korean patients with non valvular atrial fibrillation in the era of non Vitamin K Antagonist oral anticoagulants a nationwide population based study
PLOS ONE, 2017Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Gregory Y H LipAbstract:BACKGROUND Following their introduction, the non-Vitamin K Antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroKe prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs. METHODS AND RESULTS Using the National Health Insurance Service database of the entire Korean adult AF population, the use of aspirin, Vitamin K Antagonist, and NOACs between 2008 and 2015 were analyzed (n = 276,246 in 2015). Most of the included cohort had CHA2DS2-VASc score ≥ 2 (78.2% in 2008 and 83.2% in 2015), yet approximately 17% were prescribed no antithrombotic therapy throughout the study period. Aspirin prescription consistently decreased (from 48.2% to 31.5%) over time, while OAC prescription significantly increased from 34.7% to 50.6%. NOAC prescriptions accounted for 50% of total OAC prescription in 2015. Similar trends in antithrombotic therapy were found both in men and in women, but women were more liKely to be undertreated with OAC. Female gender, presence of vascular disease and prior intracranial hemorrhage were associated with OAC underuse. CONCLUSIONS Between 2008 and 2015, a greater proportion of AF patients received OAC treatment with increasing NOAC prescription trends in the recent 3 years. A substantial proportion (approx. 50%) of Korean patients with AF still remain undertreated.
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effectiveness and safety of non Vitamin K Antagonist oral anticoagulants in asian patients with atrial fibrillation
Stroke, 2017Co-Authors: Myung Jin Cha, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Woo Hyun Lim, Gregory Y H LipAbstract:BacKground and Purpose— There are limited real-world data comparing the effectiveness and safety of non-Vitamin K Antagonist oral anticoagulants (NOACs) and warfarin in Asians with nonvalvular atrial fibrillation. We aimed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population, with particular focus on high-risK patients. Methods— Using the Korean National Health Insurance Service database, we analyzed the risK of ischemic stroKe, intracranial hemorrhage (ICH) events, and all-cause death in NOAC users (n=11 611 total, n=5681 taKing rivaroxaban, n=3741 taKing dabigatran, and n=2189 taKing apixaban) compared with propensity score-matched warfarin users (n=23 222) among patients with high-risK atrial fibrillation (CHA 2 DS 2 -VASc score ≥2) between 2014 and 2015. Results— NOAC treatment was associated with similar risK of ischemic stroKe and lower risK of ICH and all-cause mortality compared with warfarin. All 3 NOACs were associated with a similar risK of ischemic stroKe and a lower risK of ICH compared with warfarin. Dabigatran and apixaban were associated with a lower risK of total mortality and the composite net clinical outcome (ischemic stroKe, ICH, and all-cause death) compared with warfarin, whereas this was nonsignificant for rivaroxaban. Among previously oral anticoagulant–naive patients (n=23 262), dabigatran and apixaban were superior to warfarin for ICH prevention, whereas rivaroxaban and warfarin were associated with similar risK of ICH. Conclusions— In real-world practice among a high-risK Asian atrial fibrillation population, all 3 NOACs demonstrated similar risK of ischemic stroKe and lower risK of ICH compared with warfarin. All-cause mortality was significantly lower only with dabigatran and apixaban.
Kyung Do Han - One of the best experts on this subject based on the ideXlab platform.
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non Vitamin K Antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease
Journal of Clinical Medicine, 2019Co-Authors: Inki Moon, Gregory Y H Lip, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Euijae LeeAbstract:BacKground: There are limited data for non-Vitamin K Antagonist oral anticoagulants (NOACs) impact on outcomes for patients with atrial fibrillation (AF) and valvular heart diseases (VHDs). Methods: We identified patients with AF and associated Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHDs, and who had been naive from the oral anticoagulants in the Korean National Health Insurance Service database between 2014 and 2016 (warfarin: n = 2671; NOAC: n = 3058). For analyzing the effect of NOAC on primary prevention, we excluded those with a previous history of ischemic stroKe, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding events. To balance covariates, we used the propensity score weighting method. Ischemic stroKe, ICH, GI bleeding, major bleeding, all-cause death, and their composite outcome and fatal clinical events were evaluated. Results: During a follow-up with a mean duration of 1.4 years, NOACs were associated with lower risKs of ischemic stroKe (hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.53–0.96), GI bleeding (HR: 0.50, 95% CI: 0.35–0.72), fatal ICH (HR: 0.28, 95% CI: 0.07–0.83), and major bleeding (HR: 0.61, 95% CI: 0.45–0.80) compared with warfarin. Overall, NOACs were associated with a lower risK of the composite outcome (HR: 0.68, 95% CI: 0.58–0.80). Conclusions: In this nationwide Asian AF population with EHRA type 2 VHDs, NOAC use was associated with lower risKs of ischemic stroKe, major bleeding, all-cause death, and the composite outcome compared to warfarin use.
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Non-Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Supranormal Renal Function
Stroke, 2019Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Jin Hyung Jung, Gregory Y H LipAbstract:BacKground and Purpose— In clinical trials, the reduced efficacy of non–Vitamin K Antagonist oral anticoagulants (NOACs) for stroKe prevention was reported for patients with nonvalvular atrial fibr...
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temporal trends of antithrombotic therapy for stroKe prevention in Korean patients with non valvular atrial fibrillation in the era of non Vitamin K Antagonist oral anticoagulants a nationwide population based study
PLOS ONE, 2017Co-Authors: So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Myung Jin Cha, Gregory Y H LipAbstract:BACKGROUND Following their introduction, the non-Vitamin K Antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroKe prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs. METHODS AND RESULTS Using the National Health Insurance Service database of the entire Korean adult AF population, the use of aspirin, Vitamin K Antagonist, and NOACs between 2008 and 2015 were analyzed (n = 276,246 in 2015). Most of the included cohort had CHA2DS2-VASc score ≥ 2 (78.2% in 2008 and 83.2% in 2015), yet approximately 17% were prescribed no antithrombotic therapy throughout the study period. Aspirin prescription consistently decreased (from 48.2% to 31.5%) over time, while OAC prescription significantly increased from 34.7% to 50.6%. NOAC prescriptions accounted for 50% of total OAC prescription in 2015. Similar trends in antithrombotic therapy were found both in men and in women, but women were more liKely to be undertreated with OAC. Female gender, presence of vascular disease and prior intracranial hemorrhage were associated with OAC underuse. CONCLUSIONS Between 2008 and 2015, a greater proportion of AF patients received OAC treatment with increasing NOAC prescription trends in the recent 3 years. A substantial proportion (approx. 50%) of Korean patients with AF still remain undertreated.
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effectiveness and safety of non Vitamin K Antagonist oral anticoagulants in asian patients with atrial fibrillation
Stroke, 2017Co-Authors: Myung Jin Cha, So Ryoung Lee, Eue Keun Choi, Kyung Do Han, Woo Hyun Lim, Gregory Y H LipAbstract:BacKground and Purpose— There are limited real-world data comparing the effectiveness and safety of non-Vitamin K Antagonist oral anticoagulants (NOACs) and warfarin in Asians with nonvalvular atrial fibrillation. We aimed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population, with particular focus on high-risK patients. Methods— Using the Korean National Health Insurance Service database, we analyzed the risK of ischemic stroKe, intracranial hemorrhage (ICH) events, and all-cause death in NOAC users (n=11 611 total, n=5681 taKing rivaroxaban, n=3741 taKing dabigatran, and n=2189 taKing apixaban) compared with propensity score-matched warfarin users (n=23 222) among patients with high-risK atrial fibrillation (CHA 2 DS 2 -VASc score ≥2) between 2014 and 2015. Results— NOAC treatment was associated with similar risK of ischemic stroKe and lower risK of ICH and all-cause mortality compared with warfarin. All 3 NOACs were associated with a similar risK of ischemic stroKe and a lower risK of ICH compared with warfarin. Dabigatran and apixaban were associated with a lower risK of total mortality and the composite net clinical outcome (ischemic stroKe, ICH, and all-cause death) compared with warfarin, whereas this was nonsignificant for rivaroxaban. Among previously oral anticoagulant–naive patients (n=23 262), dabigatran and apixaban were superior to warfarin for ICH prevention, whereas rivaroxaban and warfarin were associated with similar risK of ICH. Conclusions— In real-world practice among a high-risK Asian atrial fibrillation population, all 3 NOACs demonstrated similar risK of ischemic stroKe and lower risK of ICH compared with warfarin. All-cause mortality was significantly lower only with dabigatran and apixaban.
