Non-vitamin K antagonist oral anticoagulants beneficial in real-world population
In a real-world population with atrial fibrillation, non-vitamin K antagonist oral anticoagulants demonstrated greater clinical benefit regarding mortality and major bleeding compared with vitamin K antagonists, researchers reported.
“Non-vitamin K antagonist oral anticoagulants are recommended in international guidelines as broadly preferrable to vitamin K antagonists in the vast majority of patients with AF since the clinical trials have consistently shown noninferiority in efficacy and better safety with reduced risk of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants,” A. John Camm, MD, professor of clinical cardiology at St. George’s Hospital, London, and colleagues wrote in Heart. “Our results, from the real world, strengthen this recommendation and demonstrate the benefits of non-vitamin K antagonist oral anticoagulants in everyday clinical practice in patients with AF.”
The GARFIELD-AF prospective, multinational, observational study included 25,551 adults who were recently diagnosed with nonvalvular AF and had at least one stroke risk factor. Researchers collected data on congestive HF, hypertension, diabetes, prior stroke, transient ischemic attack, thromboembolism, vascular disease and sex category.
Vitamin K antagonist treatment was used in 8,605 patients (median age, 73 years; 52% men), direct thrombin inhibitor treatment was used in 2,090 patients (median age, 72 years; 55% men), factor Xa inhibitor treatment was used in 7,694 patients (median age, 75 years; 53% men) and 7,162 patients (median age, 73 years; 54% men) were not treated with any oral anticoagulants. Researchers compared all-cause mortality, nonhemorrhagic stroke/systemic embolism and major bleeding over 2 years in all patients.
Compared with no oral anticoagulant treatment, use of any oral anticoagulant was associated with reduced risk for mortality (HR = 0.82; 95% CI, 0.74-0.91) and nonhemorrhagic stroke/systemic embolism (HR = 0.71; 95% CI, 0.57-0.88), but increased risk for bleeding (HR = 1.46; 95% CI, 1.15-1.86), according to the researchers.
However, compared with no oral anticoagulant treatment, non-vitamin K antagonist oral anticoagulant treatment lowered risk for mortality (HR = 0.67; 95% CI, 0.59-0.77) and nonhemorrhagic stroke/systemic embolism (HR = 0.65; 95% CI, 0.5-0.86) but also resulted in no increase in major bleeding (HR = 1.1; 95% CI, 0.82-1.47), the researchers wrote.
Compared with vitamin K antagonists, non-vitamin K antagonist oral anticoagulant treatment was associated with lower risks for all-cause mortality with 3.6 vs. 4.8 per 100 patient-years (HR = 0.79; 95% CI, 0.7-0.89) and major bleeding with 1 vs. 1.4 per 100 patient-years (HR = 0.77; 95% CI, 0.61-0.98).
Researchers observed a similar risk for nonhemorrhagic stroke/systemic embolism for non-vitamin K antagonist oral anticoagulant treatment and vitamin K antagonists (0.8 vs. 1, respectively; HR = 0.96; 95% CI, 0.73-1.25).
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