期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 8, 期 9, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.119.012029
关键词
anemia; anticoagulation; atrial fibrillation; bleeding; outcome
资金
- Chang Gung Memorial Hospital [CORPG3G0271]
- Chang Gung University, Taoyuan, Taiwan [CIRPD1D0031]
Background-Major randomized trials assessing non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation generally excluded patients with hemoglobin <10 g/dL. This study evaluated the safety and effectiveness of NOACs in patients with atrial fibrillation and anemia. Methods and Results-A cohort study based on electronic medical records was conducted from 2010 to 2017 at a multicenter healthcare provider in Taiwan. It included 8356 patients with atrial fibrillation who had received oral anticoagulants (age, 77.0 +/- 7.3 years; 48.0% women). Patients were classified into 2 subgroups: 7687 patients with hemoglobin >= 10 g/dL and 669 patients with hemoglobin <10 g/dL. A Cox regression analysis was performed to assess the risks of ischemic stroke/systemic embolism, bleeding, and death associated with NOAC versus warfarin in both subgroups, respectively. In patients with hemoglobin >= 10 g/dL, NOAC (n=4793) was associated with significantly lower risks of ischemic stroke/systemic embolism, major bleeding, and gastrointestinal tract bleeding than warfarin (n=2894); there was no difference in the risk of death. In patients with hemoglobin <10 g/dL, NOAC (n=390) was associated with significantly lower risks of major bleeding (adjusted hazard ratio, 0.43; 95% CI, 0.30-0.62) and gastrointestinal tract bleeding than warfarin (n 279), but there was no difference in the risk of ischemic stroke/systemic embolism (adjusted hazard ratio, 0.79; 95% CI, 0.53-1.17) or death. Subgroup analyses suggested that NOAC was associated with fewer bleeding events, irrespective of cancer or peptic ulcer disease history. Conclusions-In patients with atrial fibrillation with hemoglobin <10 g/dL, NOAC was associated with lower bleeding risks than warfarin, with no difference in the risk of ischemic stroke/systemic embolism or death.
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