Incidence of thromboembolic and bleeding events in patients with newly diagnosed nonvalvular atrial fibrillation: An Asian multicenter retrospective cohort study in Singapore

Background Real‐world effectiveness and safety of antithrombotics in nonvalvular atrial fibrillation (NVAF) patients in Singapore has not been thoroughly studied. Hypothesis. Users of various antithrombotics experience a significantly different risk of stroke and major bleed compared with warfarin u...

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Published in:	Clinical cardiology (Mahwah, N.J.) Vol. 40; no. 12; pp. 1218 - 1226
Main Authors:	Wee, Xue Ting, Ho, Lih Maan, Ho, Han Kiat, Lee, Joyce Yu‐Chia, Yap, Chun Wei, William, Henry, Chan, Linus Chong En, Tay, Hooi Ching, Goh, Cynthia Eei Mei, Tan, Doreen Su‐Yin
Format:	Journal Article
Language:	English
Published:	New York Wiley Periodicals, Inc 01-12-2017 John Wiley & Sons, Inc
Subjects:	Aged Aged, 80 and over Anticoagulants Anticoagulation Antithrombotics Asian Atrial Fibrillation Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Cardiac arrhythmia Clinical Investigations Cohort analysis Female Fibrinolytic Agents - pharmacology Follow-Up Studies Health risk assessment Hemorrhage - chemically induced Hemorrhage - epidemiology Humans Incidence Male Middle Aged Retrospective Studies Risk Assessment Risk Factors Singapore - epidemiology Stroke - epidemiology Stroke - etiology Stroke - prevention & control Thromboembolism Thromboembolism - epidemiology Thromboembolism - etiology Thromboembolism - prevention & control Thrombosis/Hypercoagulable States Thrombosis/Hypercoagulable States Antithrombotics Anticoagulation Asian Atrial Fibrillation
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Summary:	Background Real‐world effectiveness and safety of antithrombotics in nonvalvular atrial fibrillation (NVAF) patients in Singapore has not been thoroughly studied. Hypothesis. Users of various antithrombotics experience a significantly different risk of stroke and major bleed compared with warfarin users. Methods This multicenter retrospective cohort study included patients age ≥ 21 years newly diagnosed with NVAF between July 2012 and September 2015. Using electronic medical records, data on patients' demographics, antithrombotics prescribed, and CHA2DS2‐VASc and HAS‐BLED risk factors were collected. Patients were followed for 1 year from diagnosis for the primary effectiveness and safety endpoints of incident stroke or systemic embolism and major bleed, respectively. The secondary safety endpoint was overall bleed. Hazard ratios (HR) were determined from Cox regression. Results Of 743 patients included, 224 were on warfarin, 156 on direct oral anticoagulants (DOACs), 277 on single antiplatelet therapy (SAPT), 28 on dual antiplatelet therapy (DAPT), and 58 on no therapy. Mean age (±SD) was 68.7 ± 13.0 years. Compared with warfarin users, SAPT (adjusted [adj.] HR: 3.70, 95% confidence interval [CI]: 1.21‐11.3) and DAPT users (adj. HR: 10.1, 95% CI: 1.51‐67.2) were more likely to develop thromboembolic outcomes. Also, DOAC users (adj. HR: 0.304, 95% CI: 0.158‐0.585), SAPT users (adj. HR: 0.142, 95% CI: 0.0680‐0.295), and DAPT users (adj. HR: 0.112, 95% CI: 0.0146‐0.857) were less likely to experience any bleed compared with warfarin users. Conclusions SAPT and DAPT are less effective than warfarin in NVAF patients. DOACs may be considered in view of lower risk of overall bleed.
ISSN:	0160-9289 1932-8737
DOI:	10.1002/clc.22811