Yamkasikorn Janekij, Methavigul Komsing
Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi 11000, Thailand.
Asian Biomed (Res Rev News). 2022 Jun 30;16(3):131-136. doi: 10.2478/abm-2022-0016. eCollection 2022 Jun.
In trials of patients with atrial fibrillation (AF), non-vitamin K antagonist oral anticoagulants (NOACs) were not inferior to warfarin for thromboembolic and bleeding events. However, there are scant data comparing the efficacy and safety of NOACs in patients with AF with that of well-controlled warfarin treatment in such patients.
To compare total bleeding and thromboembolic events in patients with AF who received NOACs, with the same events in those who received well-controlled warfarin treatment.
We used retrospective data from patients with AF who received NOACs or well-controlled warfarin at the Central Chest Institute of Thailand from January 2017 to December 2019. The primary outcome was total bleeding or thromboembolic events or both. The secondary outcome was all-cause mortality, total bleeding events including major or minor bleeding, and thromboembolic events including ischemic stroke or systemic embolization.
We included data from 180 patients with AF, 90 who received NOACs and 90 who received well-controlled warfarin. The average time in the therapeutic range for those who received warfarin was 84.9% ± 9.8%. The patients who received well-controlled warfarin had more frequent thromboembolic or total bleeding events or both than those who received NOACs (odds ratio [OR] 3.17; 95% confidence interval [CI] 2.27-4.07; = 0.01). There were more minor bleeding events in those who received well-controlled warfarin (OR 3.75; 95% CI 2.79-4.71; = 0.01). However, there was no significant difference in thromboembolic events, major bleeding, or all-cause mortality between the 2 groups.
Thai patients with AF who received NOACs had less thromboembolic or total bleeding events than those who received well-controlled warfarin treatment.
在心房颤动（AF）患者的试验中，非维生素K拮抗剂口服抗凝药（NOACs）在血栓栓塞和出血事件方面并不逊于华法林。然而，在AF患者中，将NOACs的疗效和安全性与华法林良好控制治疗的疗效和安全性进行比较的数据很少。
比较接受NOACs的AF患者与接受华法林良好控制治疗的患者的总出血和血栓栓塞事件。
我们使用了2017年1月至2019年12月在泰国中央胸部研究所接受NOACs或华法林良好控制治疗的AF患者的回顾性数据。主要结局是总出血或血栓栓塞事件或两者兼有。次要结局是全因死亡率、包括大出血或小出血的总出血事件以及包括缺血性中风或全身性栓塞的血栓栓塞事件。
我们纳入了180例AF患者的数据，其中90例接受NOACs，90例接受华法林良好控制治疗。接受华法林治疗的患者在治疗范围内的平均时间为84.9%±9.8%。接受华法林良好控制治疗的患者比接受NOACs的患者发生血栓栓塞或总出血事件或两者兼有的频率更高（优势比[OR]3.17；95%置信区间[CI]2.27-4.07；P=0.01）。接受华法林良好控制治疗的患者发生小出血事件的情况更多（OR 3.75；95%CI 2.79-4.71；P=0.01）。然而，两组之间在血栓栓塞事件、大出血或全因死亡率方面没有显著差异。
接受NOACs的泰国AF患者比接受华法林良好控制治疗的患者发生血栓栓塞或总出血事件的情况更少。
