Abstract
Introduction
Outcomes associated with suboptimal use of antithrombotic treatments (antiplatelets, warfarin, direct oral anticoagulants [DOACs]) are unclear in Chinese patients with atrial fibrillation (AF).
Objectives
Our objective was to assess the prescription patterns, quality, effectiveness, and safety of antithrombotic treatments.
Methods
This was a population-based cohort study using electronic health records in Hong Kong. Patients newly diagnosed with AF during 2010–2016 were followed up until 2017. Patients at high stroke risk (CHA2DS2-VASc score ≥ 2) and receiving antithrombotic treatments were matched using propensity scoring. We used Cox proportional hazards regression to compare the risks of ischemic stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), and all-cause mortality between groups.
Results
Of the 52,178 high-risk patients with AF, 27,614 (52.9%) received antithrombotic treatment and were included in the analyses. Between 2010 and 2016, prescribing of antiplatelets and warfarin declined and that of DOACs increased dramatically (from 1 to 32%). Two-thirds of warfarin users experienced poor anticoagulation control. Warfarin and DOACs were associated with lower risks of ischemic stroke (warfarin, hazard ratio [HR] 0.51 [95% confidence interval (CI) 0.36–0.71]; DOACs, HR 0.69 [95% CI 0.51–0.94]) and all-cause mortality (warfarin, HR 0.47 [95% CI 0.39–0.57]; DOACs, HR 0.45 [95% CI 0.37–0.55]) than were antiplatelets. DOACs were associated with a lower risk of ICH than was warfarin (HR 0.53 [95% CI 0.34–0.83]). GIB risks were similar among all groups.
Conclusion
Antiplatelet prescribing and suboptimal warfarin management remain common in Chinese patients with AF at high risk of stroke. DOAC use may be associated with a lower risk of ischemic stroke and all-cause mortality when compared with antiplatelets and with a lower risk of ICH when compared with warfarin.
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Acknowledgements
The authors thank Ms Lisa Lam and Mr Edmund Cheung, Department of Pharmacology and Pharmacy, University of Hong Kong, for proofreading this manuscript.
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Funding
This work was supported by the University of Hong Kong-University College London (HKU-UCL) Strategic Partnership Fund and an unconditional education grant from Pfizer Corporation Hong Kong Limited. The funders had no role in the study design, data collection and analysis, preparation of the manuscript, or decision to publish.
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The datasets generated during and/or analysed during the current study are not publicly available because of the nature of sensitive electronic medical data. Code will be available upon request from the corresponding author.
Conflict of interest
EW Chan has received honoraria from the HA and research funding from The Hong Kong Research Grants Council; The Research Fund Secretariat of the Food and Health Bureau; the Narcotics Division of the Security Bureau of HKSAR, Hong Kong; the National Natural Science Fund of China, China; the Wellcome Trust, UK; Bayer; Bristol Myers Squibb; Pfizer, and Takeda for work unrelated to this study. ICK Wong has received research funding outside the submitted work from Bristol Myers Squibb, Janssen, Bayer, Novartis, GSK, the Hong Kong Research Grants Council, and the Hong Kong Health and Medical Research Fund. X Li has received research grants from the Hong Kong Health and Medical Research Fund and Janssen and internal seed funding from the University of Hong Kong unrelated to this work. KKC Man received the CW Maplethorpe Fellowship and personal fees from IQVIA Holdings, Inc. (previously known as QuintilesIMS Holdings, Inc.) unrelated to this work. SP, VWSN, CWS, and WCYL have no conflicts of interests that are directly relevant to the content of this study.
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This study protocol was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference no. UW13-468).
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Li, X., Pathadka, S., Man, K.K.C. et al. Comparative Outcomes Between Direct Oral Anticoagulants, Warfarin, and Antiplatelet Monotherapy Among Chinese Patients with Atrial Fibrillation: A Population-Based Cohort Study. Drug Saf 43, 1023–1033 (2020). https://doi.org/10.1007/s40264-020-00961-0
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DOI: https://doi.org/10.1007/s40264-020-00961-0