Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand.
Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMC Cardiovasc Disord. 2023 Jan 23;23(1):43. doi: 10.1186/s12872-023-03053-w.
This study aimed to investigate the efficacy and safety outcomes of patients with atrial fibrillation (AF) compared between those taking warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) based on SAMe-TTR score.
AF patients using warfarin or NOACs were enrolled from Thailand's COOL-AF registry. A low SAMe-TTR score was defined as a score of 0-2. The efficacy outcomes were all-cause death, ischemic stroke (IS), transient ischemic attack (TIA), and/or systemic embolization (SE). The safety outcome was major bleeding (MB). The secondary outcome was a combination of cardiovascular (CV) death, IS/TIA/SE, or MB. Cox proportional hazards model was used to compare the event rate between the AF patients taking warfarin and NOACs according to SAMe-TTR score.
A total of 2568 AF patients taking oral anticoagulants were enrolled. Warfarin and NOACs were used in 2340 (91.1%) and 228 (8.9%) patients, respectively. Among overall patients, 305 patients taking warfarin (13.0%) and 21 patients taking NOACs (9.2%) had the efficacy outcome, while 155 patients taking warfarin (6.6%) and 11 patients taking NOACs (4.8%) had the safety outcome. After adjustment for confounders, overall patients taking warfarin had significantly more secondary outcome than those taking NOACs (11.4% vs. 7.5%, respectively; adjusted hazard ratio: 1.74, 95% confidence interval: 1.01-2.99; p = 0.045) regardless of SAMe-TTR score.
AF patients taking warfarin had a significantly higher CV death or IS/TIA/SE or MB compared to those taking NOACs regardless of SAMe-TTR score. The results of this study do not support the use of SAMe-TTR score to guide OAC selection.
本研究旨在根据 SAMe-TTR 评分比较服用华法林和非维生素 K 拮抗剂口服抗凝剂 (NOAC) 的房颤 (AF) 患者的疗效和安全性结局。
从泰国 COOL-AF 登记处招募使用华法林或 NOAC 的 AF 患者。低 SAMe-TTR 评分定义为评分 0-2。疗效结局为全因死亡、缺血性卒中 (IS)、短暂性脑缺血发作 (TIA) 和/或全身性栓塞 (SE)。安全性结局为大出血 (MB)。次要结局为心血管 (CV) 死亡、IS/TIA/SE 或 MB 的组合。使用 Cox 比例风险模型比较根据 SAMe-TTR 评分，服用华法林和 NOAC 的 AF 患者的事件发生率。
共纳入 2568 例服用口服抗凝剂的 AF 患者。华法林和 NOAC 分别用于 2340 例 (91.1%) 和 228 例 (8.9%) 患者。在所有患者中，305 例服用华法林 (13.0%) 和 21 例服用 NOAC (9.2%) 的患者出现疗效结局，而 155 例服用华法林 (6.6%) 和 11 例服用 NOAC (4.8%) 的患者出现安全性结局。调整混杂因素后，服用华法林的所有患者的次要结局发生率明显高于服用 NOAC 的患者 (分别为 11.4%和 7.5%；调整后的风险比：1.74，95%置信区间：1.01-2.99；p=0.045)，无论 SAMe-TTR 评分如何。
无论 SAMe-TTR 评分如何，服用华法林的 AF 患者的 CV 死亡或 IS/TIA/SE 或 MB 发生率明显高于服用 NOAC 的患者。本研究结果不支持使用 SAMe-TTR 评分来指导 OAC 选择。
