ABSTRACT
Edoxaban, a once-daily, direct-acting oral anticoagulant, is approved to prevent stroke or systemic embolism in non-valvular atrial fibrillation (NVAF) and treat venous thromboembolism. The clinical benefit of edoxaban for stroke prevention in Asian patients with NVAF has been demonstrated in clinical and real-world studies. We share early clinical experiences with once-daily edoxaban and discuss its evidence-based use in patients with NVAF in Southeast Asia through several cases of patients at high risk, including frail patients, elderly patients with multiple comorbidities and patients with increased bleeding risk. These cases demonstrate the effectiveness and safety of once-daily edoxaban in patients with NVAF in Southeast Asia.
ABSTRACT
Introduction: Atrial fibrillation (AF) is the most commoncardiac arrhythmia with significant morbidity and mortalityin relation to thromboembolic stroke. Our study aimed toevaluate the safety and efficacy of dabigatran in strokeprevention in elderly patient with nonvalvular AF with regardto the risk of ischemic stroke and intracranial haemorrhage(ICH) in real-world setting.Methods: A retrospective cohort study of 200 patients ondabigatran and warfarin from January 2009 till September2016 was carried out. Data were collected for 100 patients ondabigatran and 100 patients on warfarin.Results: The mean follow-up period was 340.7±322.3 daysfor dabigatran group and 410.5±321.2 days for warfaringroup. The mean time in therapeutic range (TTR) was52±18.7%. The mean CHA2DS2 -VASc score for dabigatrangroup was 4.4±1.1 while 5.0±1.5 for warfarin group. None indabigatran group experienced ischemic stroke compared toone patient in warfarin group (p=0.316). There was onepatient in dabigatran group suffered from ICH compared tonone in warfarin group (p=0.316). Four patients in warfaringroup experienced minor bleeding, while none fromdabigatran group (p=0.043).Conclusion: Overall bleeding events were significantly lowerin dabigatran group compared to warfarin group. In thepresence of suboptimal TTR rates and inconveniences withwarfarin therapy, non-vitamin-K antagonist oralanticoagulants (NOAC) are the preferred agents for strokeprevention in elderly Asian patients for nonvalvula
ABSTRACT
BACKGROUND: The Asian population with atrial fibrillation (AF) have a higher risk of stroke than the caucasian population and a higher risk of intracranial bleeding when anticoagulated with warfarin. There are few real-world studies comparing the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin among Asian patients to assess its outcomes of ischemic stroke and hemorrhagic stroke. METHODS: A retrospective cohort study of 1000 patients on dabigatran and warfarin from 2009 to 2013. RESULTS: Data were available for 500 patients on dabigatran and 500 patients on warfarin. The average follow-up duration was 315 ± 280 days in the dabigatran group and 355 ± 232 in the warfarin group. The time in therapeutic range (TTR) was 53.2% in the warfarin-treated group, with 32.8% of patients in the subtherapeutic international normalized ratio range of <2. None of the patients in the dabigatran group had ischemic cerebrovascular accident (CVA) compared to 4 (0.8%) patients in the warfarin group, hazard ratio (HR) 0.13, P = .3. There was 1 (0.2%) patient in both dabigatran and warfarin groups with hemorrhagic CVA (HR 1.16, P = .92). There were 3 (0.6%) patients with major bleeding in the dabigatran group compared to 2 (0.4%) patients in the warfarin group (HR 1.57, P = .59). CONCLUSION: There were similar rates of efficacy for outcomes of ischemic CVA, hemorrhagic CVA, and bleeding when comparing dabigatran with warfarin. Our study shows that despite similar efficacy, suboptimal TTR rates and inconveniences with warfarin demonstrate that NOACs are preferred for stroke prevention in AF.
