Newer oral anticoagulants reduce event risk in AF, GI bleeding vs. warfarin
Non-vitamin K antagonist oral anticoagulants conferred lower risk for ischemic stroke and major bleeding in patients with atrial fibrillation and a history of gastrointestinal bleeding compared with warfarin, according to study results.
“Oral anticoagulant therapy is essential for the prevention of thromboembolic events in patients with AF. The introduction of non-vitamin K antagonist oral anticoagulants has facilitated uptake of thromboprophylaxis,” Soonil Kwon, MD, from Seoul National University Hospital in South Korea, and colleagues wrote. “However, the effectiveness and safety of non-vitamin K antagonist oral anticoagulants in AF patients at high bleeding risk have not been well documented.”
In a retrospective, observational cohort study, researchers analyzed 42,048 patients (mean age, 72 years; 57% men) with AF and prior gastrointestinal (GI) bleeding to evaluate the safety and efficacy of non-vitamin K antagonist oral anticoagulant use vs. warfarin use (58.9% of patients vs. 41.1% of patients, respectively). The mean time from prior GI bleeding to oral anticoagulant initiation was 3.1 years; outcomes of interest included ischemic stroke, major bleeding, combined ischemic stroke/major bleeding and mortality. The researchers used inverse probability of treatment weighting to balance baseline characteristics between the groups.
After a median follow-up of 0.6 years, 3.4% of patients experienced ischemic stroke, 2.5% major bleeding and 5.7% ischemic stroke/major bleeding. Compared with warfarin users, non-vitamin K antagonist oral anticoagulant users had lower rates of ischemic stroke (HR = 0.608; 95% CI, 0.543-0.68), major bleeding (HR = 0.731; 95% CI, 0.642-0.832) and ischemic stroke/major bleeding (HR = 0.661; 95% CI, 0.606-0.721).
The researchers also found non-vitamin K antagonist oral anticoagulant use was associated with an 18% lower risk for all-cause mortality compared with warfarin.
“In this nationwide cohort study, non-vitamin K antagonist oral anticoagulants were associated with lower risks of ischemic stroke and major bleeding than warfarin among AF patients with prior GI bleeding. Non-vitamin K antagonist oral anticoagulants were also associated with a lower rate of fatalities from each clinical outcome compared with warfarin,” Kwon and colleagues wrote. “Non-vitamin K antagonist oral anticoagulants may be a better option than warfarin for stroke prevention in AF patients with prior GI bleeding.”