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Chan YH, Yen KC, See LC, Chang SH, Wu LS, Lee HF, Tu HT, Yeh YH, Kuo CT. Cardiovascular, Bleeding, and Mortality Risks of Dabigatran in Asians With Nonvalvular Atrial Fibrillation. Stroke 2016; 47:441-9. [PMID: 26732563 DOI: 10.1161/strokeaha.115.011476] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/19/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Whether dabigatran is associated with different risks of cardiovascular, bleeding events, and mortality from warfarin in Asian patients with nonvalvular atrial fibrillation remains unclear. METHODS We used the Taiwan National Health Insurance Research Database to obtain 9940 and 9913 nonvalvular atrial fibrillation patients taking dabigatran and warfarin, respectively, from June 1, 2012, to December 31, 2013, as the dynamic cohort. Inverse probability of treatment weighting using propensity scores was used to balance covariates across 2 study groups. Patients were followed up until the first occurrence of any study outcome or end date of study. RESULTS During a median follow-up period of 0.67 years, there were 526 outcomes for dabigatran group. The hazard ratios (95% confidence intervals) comparing dabigatran with warfarin (reference) were as follows: ischemic stroke, 0.62 (0.52-0.73; P<0.0001); myocardial infarction, 0.67 (0.43-1.05; P=0.0803); intracranial hemorrhage, 0.44 (0.32-0.60; P<0.0001); major gastrointestinal bleeding, 0.99 (0.66-1.49; P=0.9658); all hospitalized major bleeding, 0.58 (0.46-0.74; P<0.0001); and all-cause mortality, 0.45 (0.38-0.53; P<0.0001). Dabigatran did not increase the risk of myocardial infarction or major gastrointestinal bleeding in all age groups when compared with warfarin. Total 8772 patients (88%) took a 110-mg dose in dabigatran group. The magnitude of effect for each outcome of 110-mg was comparable with that of 150-mg dose in the subgroup analysis. CONCLUSIONS In real-world practice, dabigatran was associated with a reduced risk of ischemic stroke, intracranial hemorrhage, all hospitalized major bleeding, and all-cause mortality compared with warfarin in Asian patients with nonvalvular atrial fibrillation. Dabigatran did not increase the risk of major gastrointestinal bleeding or myocardial infarction compared with warfarin.
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Affiliation(s)
- Yi-Hsin Chan
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Kun-Chi Yen
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Lai-Chu See
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Shang-Hung Chang
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Lung-Sheng Wu
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Hsin-Fu Lee
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Hui-Tzu Tu
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Yung-Hsin Yeh
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.)
| | - Chi-Tai Kuo
- From the Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); College of Medicine, Chang Gung University, Taoyuan, Taiwan (Y.-H.C., K.-C.Y., S.-H.C., L.-S.W., H.-F.L., Y.-H.Y., C.-T.K.); Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan (L.-C.S., H.-T.T.); and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan (L.-C.S.).
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