Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
Department of Pharmacy, Veterans General Hospital, Taipei, Taipei City, Taiwan.
J Thromb Thrombolysis. 2024 Oct;57(7):1268-1280. doi: 10.1007/s11239-024-03016-8. Epub 2024 Aug 14.
It remains unclear whether non-vitamin K antagonist oral anticoagulants (NOACs) are more effective and safer than warfarin in low-weight patients with atrial fibrillation (AF). Here, we retrospectively compared the effectiveness and safety of NOACs with those of warfarin in low-weight patients with AF. We extracted the July 2011-September 2022 data of patients with AF treated with a NOAC (dabigatran, rivaroxaban, apixaban, or edoxaban) or warfarin at a tertiary hospital. The patients were divided into low-weight (body weight ≤ 60 kg) and non-low-weight (body weight = 60-100 kg) groups. The primary outcomes were hospitalization for ischemic stroke (IS) or systemic embolism (SE) and major bleeding, whereas the secondary outcomes were any ischemic and bleeding events. We used the inverse probability of treatment weighting to balance the baseline characteristics between the groups. In total, 5,044 patients (mean age = 73.7 years, mean CHA2DS2-VASc score = 3.0, mean HAS-BLED score = 2.3) were enrolled and divided into low-weight and non-low-weight groups-containing 1,666 (1,406 NOAC users, 260 warfarin users) and 3,378 (2,978 NOAC users, 400 warfarin users) patients, respectively. NOACs were associated with a lower risk of any bleeding event in the low-weight group (adjusted hazard ratio = 0.61, 95% confidence interval = 0.51-0.73). The between-group differences in the risks of IS/SE, any ischemic event, major bleeding, and any bleeding event were nonsignificant. Thus, the use of NOACs (specifically dabigatran or edoxaban) is associated with a lower risk of any bleeding event than warfarin use in low-weight patients with AF.
在体重较轻的房颤（AF）患者中，非维生素 K 拮抗剂口服抗凝剂（NOACs）是否比华法林更有效且更安全仍不清楚。在此，我们回顾性比较了 NOACs 与华法林在低体重 AF 患者中的疗效和安全性。我们提取了 2011 年 7 月至 2022 年 9 月在一家三级医院接受 NOAC（达比加群、利伐沙班、阿哌沙班或依度沙班）或华法林治疗的 AF 患者的数据。患者分为低体重（体重≤60kg）和非低体重（体重=60-100kg）组。主要结局是缺血性卒中（IS）或全身性栓塞（SE）和大出血住院，次要结局是任何缺血性和出血事件。我们使用逆概率治疗加权来平衡组间的基线特征。共纳入 5044 例患者（平均年龄 73.7 岁，平均 CHA2DS2-VASc 评分 3.0，平均 HAS-BLED 评分 2.3），并分为低体重和非低体重组，分别包含 1666 例（1406 例 NOAC 使用者，260 例华法林使用者）和 3378 例（2978 例 NOAC 使用者，400 例华法林使用者）。NOACs 与低体重组任何出血事件的风险降低相关（调整后的危险比=0.61，95%置信区间=0.51-0.73）。两组间 IS/SE、任何缺血事件、大出血和任何出血事件的风险差异无统计学意义。因此，与华法林相比，在低体重 AF 患者中使用 NOAC（特别是达比加群或依度沙班）与任何出血事件的风险降低相关。
