title: A Comparison of Dabigatran With Warfarin for Stroke Prevention in Atrial Fibrillation in an Asian Population.
abstract: BACKGROUND
  The Asian population with atrial fibrillation (AF) have a higher risk of stroke than the caucasian population and a higher risk of intracranial bleeding when anticoagulated with warfarin. There are few real-world studies comparing the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin among Asian patients to assess its outcomes of ischemic stroke and hemorrhagic stroke.
  
  
  METHODS
  A retrospective cohort study of 1000 patients on dabigatran and warfarin from 2009 to 2013.
  
  
  RESULTS
  Data were available for 500 patients on dabigatran and 500 patients on warfarin. The average follow-up duration was 315 ± 280 days in the dabigatran group and 355 ± 232 in the warfarin group. The time in therapeutic range (TTR) was 53.2% in the warfarin-treated group, with 32.8% of patients in the subtherapeutic international normalized ratio range of <2. None of the patients in the dabigatran group had ischemic cerebrovascular accident (CVA) compared to 4 (0.8%) patients in the warfarin group, hazard ratio (HR) 0.13, P = .3. There was 1 (0.2%) patient in both dabigatran and warfarin groups with hemorrhagic CVA (HR 1.16, P = .92). There were 3 (0.6%) patients with major bleeding in the dabigatran group compared to 2 (0.4%) patients in the warfarin group (HR 1.57, P = .59).
  
  
  CONCLUSIONS
  There were similar rates of efficacy for outcomes of ischemic CVA, hemorrhagic CVA, and bleeding when comparing dabigatran with warfarin. Our study shows that despite similar efficacy, suboptimal TTR rates and inconveniences with warfarin demonstrate that NOACs are preferred for stroke prevention in AF.
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia dr.lokyap@ijn.com.my.
authors.forename: Lok Bin
authors.initials: LB
authors.lastname: Yap
authors.affiliation: Royal College of Medicine Perak, University KL, Perak, Malaysia.
authors.forename: Daniel Theng Sheng
authors.initials: DT
authors.lastname: Eng
authors.affiliation: Royal College of Medicine Perak, University KL, Perak, Malaysia.
authors.forename: Lingghesh
authors.initials: L
authors.lastname: Sivalingam
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Beni Isman
authors.initials: BI
authors.lastname: Rusani
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Dhanan
authors.initials: D
authors.lastname: Umadevan
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Zulkeflee
authors.initials: Z
authors.lastname: Muhammad
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Kok Wei
authors.initials: KW
authors.lastname: Koh
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Barveen
authors.initials: B
authors.lastname: Aisha
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Mohd Irwan
authors.initials: MI
authors.lastname: Hashim
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Rosila
authors.initials: R
authors.lastname: Rebo
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Azlan
authors.initials: A
authors.lastname: Hussin
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Surinder
authors.initials: S
authors.lastname: Kaur
authors.affiliation: Royal College of Medicine Perak, University KL, Perak, Malaysia.
authors.forename: Rajasingam
authors.initials: R
authors.lastname: Shanmugam
authors.affiliation: National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Razali
authors.initials: R
authors.lastname: Omar
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use*; D044466:Asian People; D001281:Atrial Fibrillation / Q000188:drug therapy*; D015331:Cohort Studies; D000069604:Dabigatran / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000991:Antithrombins; D014859:Warfarin; D000069604:Dabigatran
keywords: dabigatran; non-valvular atrial fibrillation; novel anticoagulant; stroke prevention; warfarin