Author + information
- Received November 2, 2018
- Revision received November 20, 2018
- Accepted November 26, 2018
- Published online February 25, 2019.
- So-Ryoung Lee, MDa,
- Eue-Keun Choi, MD, PhDb,∗ (, )@SNUnow@HospitalSeoul,
- Chan Soon Park, MDc,
- Kyung-Do Han, PhDd,
- Jin-Hyung Jung, BScd,
- Seil Oh, MD, PhDb and
- Gregory Y.H. Lip, MDe,f
- aDivision of Cardiology, Department of Internal Medicine, Soon Chun Hyang University Hospital Seoul, Seoul, Republic of Korea
- bDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- cGraduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
- dDepartment of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
- eLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom
- fDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark
- ↵∗Address for correspondence:
Dr. Eue-Keun Choi, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Background It is unclear whether the overall effectiveness and safety of direct oral anticoagulants (DOACs) are consistent in patients with nonvalvular atrial fibrillation (AF) and extremely low body weight (<50 kg).
Objectives This study compared DOACs with warfarin in AF patients with low body weight.
Methods Using data from the Korean National Health Insurance Service database from January 2014 to December 2016, AF patients with body weight ≤60 kg and who were treated with oral anticoagulants (n = 14,013 taking DOACs and n = 7,576 taking warfarin) were included and examined for ischemic stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding, major bleeding, all-cause death, and composite outcome. The propensity score weighting was used to balance the 2 groups.
Results Baseline characteristics were well balanced between the 2 groups (mean age 73 years, mean CHA2DS2-VASc score 4, and 28% of patients weighed <50 kg). DOACs were associated with lower risks of ischemic stroke (hazard ratio [HR]: 0.591; 95% confidence interval [CI]: 0.510 to 0.686) and major bleeding (HR: 0.705; 95%: CI 0.601 to 0.825), which were caused by a reduction in ICH (HR: 0.554; 95% CI: 0.429 to 0.713) compared with warfarin. DOAC improved the net clinical benefit compared with warfarin (HR for composite outcome: 0.660; 95% CI: 0.606 to 0.717), and this was consistent in patients who weighed <50 kg (HR for composite outcome: 0.665; 95% CI: 0.581 to 0.762).
Conclusions In this real-world Asian AF population with low body weight, DOACs showed better effectiveness and safety than warfarin. These results were consistent in patients with extremely low body weight. Regular dosages of DOACs showed comparable results as reduced dosages of DOACs in both effectiveness and safety.
- atrial fibrillation
- direct oral anticoagulant
- low body weight
- nonvitamin K antagonist oral anticoagulants
This study was supported by the Korean National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, Technology (2014R1A1A2A16055218); the Technology Innovation Program (10052668, development of wearable self-powered energy source and low-power wireless communication system for a pacemaker) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea), and Soon Chun Hyang University Research Fund. Dr. Choi has received research grants from Daiichi-Sankyo, BMS/Pfizer, and Biosense Webster. Dr. Lip has been a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo; and has been a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 2, 2018.
- Revision received November 20, 2018.
- Accepted November 26, 2018.
- 2019 American College of Cardiology Foundation
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