Comparative effectiveness and safety of direct oral anticoagulants and warfarin in atrial fibrillation patients with dementia.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-08-30 DOI:10.1177/23969873241274598
Chen-Wen Fang, Cheng-Yang Hsieh, Hsin-Yi Yang, Ching-Fang Tsai, Sheng-Feng Sung
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Abstract

Introduction: Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia.

Patients and methods: We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC.

Results: There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome.

Discussion and conclusion: Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.

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直接口服抗凝剂和华法林在心房颤动伴痴呆患者中的有效性和安全性比较。
导言:制定有效的中风预防策略对于老年心房颤动 (AF) 痴呆患者至关重要。这是因为这方面的证据有限且不一致。在这项基于人群的全国性队列研究中,我们旨在比较直接口服抗凝药(DOACs)和华法林对老年痴呆房颤患者的有效性和安全性:我们从 2010 年至 2019 年期间的台湾国民健康保险研究数据库中识别了 50 岁或以上的房颤痴呆患者。主要结果是缺血性中风、急性心肌梗死、颅内出血或大出血导致的住院治疗以及全因死亡率的复合结果。在比较华法林和DOAC(阿哌沙班、达比加群、依度沙班或利伐沙班)使用者之间或华法林和每种DOAC使用者之间的结果时,我们使用了1:1倾向得分匹配和Cox比例危险模型来调整混杂因素:DOAC与华法林匹配队列中有2952名患者。阿哌沙班、达比加群、依度沙班和利伐沙班-华法林匹配队列分别有 2346、2554、1684 和 2938 名患者。与华法林相比,DOAC组发生复合结局(危险比(HR)0.81;95% 置信区间(CI)0.69-0.95)和缺血性卒中(HR 0.65;95% CI 0.48-0.87)的风险较低。阿哌沙班(HR 0.79;95% CI 0.66-0.94)、达比加群(HR 0.64;95% CI 0.53-0.77)和利伐沙班(HR 0.82;95% CI 0.70-0.97)也与较低的综合结果风险相关:与华法林相比,DOACs(无论是作为一组药物还是阿哌沙班、达比加群或利伐沙班单独使用)与并发房颤和痴呆的老年患者的综合结局风险降低相关。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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