title: Efficacy and safety of dabigatran, rivaroxaban, and warfarin for stroke prevention in Chinese patients with atrial fibrillation: the Hong Kong Atrial Fibrillation Project.
abstract: BACKGROUND
  Little is known about the comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin in Chinese atrial fibrillation (AF) patients. Our aim was to compare the ischemic stroke risk reduction and incidence of intracranial hemorrhage (ICH) of warfarin in relation to quality of anticoagulation control (as reflected by time in therapeutic range [TTR]), and to dabigatran and rivaroxaban in a real-world cohort of Chinese AF patients.
  
  
  OBJECTIVE
  NOAC, rather than warfarin, is preferred in Chinese AF patients.
  
  
  METHODS
  Of 2099 patients studied (73.1 ± 12.3 years, female: 44.6%, CHA2DS2-VASc 3.7 ± 1.9 and HAS-BLED 2.0 ± 1.0) with nonvalvular AF, 963 patients (45.9%) were on warfarin (only 16.3% had TTR ≥65%), 669 patients were on rivaroxaban, and 467 patients were on dabigatran.
  
  
  RESULTS
  After a mean follow-up of 21.7 ± 13.4 months, there were 156 ischemic strokes (annual incidence of 4.10%/year), with the incidence of ischemic stroke being highest in patients on warfarin with TTR <65% (5.24%/year), followed by those on rivaroxaban (3.74%/year), and those on warfarin with TTR ≥65% (3.35%/year), whereas patients on dabigatran had the lowest incidence of ischemic stroke (1.89%/year). The incidence of ICH was lowest in patients on dabigatran (0.39%/year) compared with those on rivaroxaban (0.52%/year) and warfarin, with TTR <65% (0.95%/year) and TTR ≥65% (0.58%/year). Patients on rivaroxaban 20 mg daily had similar ischemic stroke risk (1.93%/year) and ICH risk (0.21%/year) compared to dabigatran.
  
  
  CONCLUSIONS
  In Chinese AF patients, the benefits of warfarin therapy for stroke prevention and ICH reduction depend on TTR. Of the treatments compared, dabigatran, as well as rivaroxaban 20 mg daily, was associated with lowest ischemic stroke and ICH rates.
authors.affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.|Department of Echocardiography and Noninvasive Cardiology Laboratory, Sichuan Academy of Medial Science and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Li
authors.affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Duo
authors.initials: D
authors.lastname: Huang
authors.affiliation: Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chern-En
authors.initials: CE
authors.lastname: Chiang
authors.affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
authors.affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
authors.affiliation: Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.
authors.forename: Esther W
authors.initials: EW
authors.lastname: Chan
authors.affiliation: Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.
authors.forename: Ian C K
authors.initials: ICK
authors.lastname: Wong
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GYH
authors.lastname: Lip
authors.affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Pak-Hei
authors.initials: PH
authors.lastname: Chan
authors.affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Chung-Wah
authors.initials: CW
authors.lastname: Siu
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000069604:Dabigatran / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000008:administration & dosage*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Atrial fibrillation; Intracranial hemorrhage; Ischemic stroke; Non-vitamin K antagonist oral anticoagulants