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Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation and Low Body Weight.

Abstract：

BACKGROUND:It is unclear whether the overall effectiveness and safety of direct oral anticoagulants (DOACs) are consistent in patients with nonvalvular atrial fibrillation (AF) and extremely low body weight (<50 kg). OBJECTIVES:This study compared DOACs with warfarin in AF patients with low body weight. METHODS:Using data from the Korean National Health Insurance Service database from January 2014 to December 2016, AF patients with body weight ≤60 kg and who were treated with oral anticoagulants (n = 14,013 taking DOACs and n = 7,576 taking warfarin) were included and examined for ischemic stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding, major bleeding, all-cause death, and composite outcome. The propensity score weighting was used to balance the 2 groups. RESULTS:Baseline characteristics were well balanced between the 2 groups (mean age 73 years, mean CHA2DS2-VASc score 4, and 28% of patients weighed <50 kg). DOACs were associated with lower risks of ischemic stroke (hazard ratio [HR]: 0.591; 95% confidence interval [CI]: 0.510 to 0.686) and major bleeding (HR: 0.705; 95%: CI 0.601 to 0.825), which were caused by a reduction in ICH (HR: 0.554; 95% CI: 0.429 to 0.713) compared with warfarin. DOAC improved the net clinical benefit compared with warfarin (HR for composite outcome: 0.660; 95% CI: 0.606 to 0.717), and this was consistent in patients who weighed <50 kg (HR for composite outcome: 0.665; 95% CI: 0.581 to 0.762). CONCLUSIONS:In this real-world Asian AF population with low body weight, DOACs showed better effectiveness and safety than warfarin. These results were consistent in patients with extremely low body weight. Regular dosages of DOACs showed comparable results as reduced dosages of DOACs in both effectiveness and safety.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Lee SR,Choi EK,Park CS,Han KD,Jung JH,Oh S,Lip GYH

doi

10.1016/j.jacc.2018.11.051

subject

Has Abstract

pub_date

2019-03-05 00:00:00

pages

919-931

issue

8

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(19)30018-X

journal_volume

73

pub_type

杂志文章,多中心研究

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