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Circ J. 2018 Sep 25;82(10):2500-2509. doi: 10.1253/circj.CJ-18-0535. Epub 2018 Aug 4.

Three-Year Clinical Outcomes Associated With Warfarin vs. Direct Oral Anticoagulant Use Among Japanese Patients With Atrial Fibrillation - Findings From the SAKURA AF Registry.

Author information

1
Division of Cardiology, Nihon University Itabashi Hospital.
2
Department of Cardiology, Nihon University Hospital.
3
Kawaguchi Municipal Medical Center.
4
Yokohama Chuo Hospital.
5
Sekishindo Hospital.
6
Asakadai Central General Hospital.
7
Tokyo Rinkai Hospital.
8
Kasukabe Municipal Hospital.
9
Yasuda Hospital.
10
Makita General Hospital.
11
Itabashi Medical Association Hospital.
12
Ukima Central Hospital.
13
Itou Cardiovascular Clinic.
14
Kondo Clinic.
15
Keiai Clinic.
16
Ohno Medical Clinic.
17
Onikura Clinic.

Abstract

BACKGROUND:

Although direct oral anticoagulants (DOACs) are widely used in Japanese patients with atrial fibrillation (AF), large-scale investigations into their use, with suitable follow-up times and rates, are lacking. Methods and Results: The SAKURA AF Registry is a prospective multicenter registry created to investigate therapeutic outcomes of oral anticoagulant (OAC) use in Japanese AF patients. We conducted a study involving 3,237 enrollees from 63 institutions in the Tokyo area being treated with any of 4 DOACs (n=1,676) or warfarin (n=1,561) and followed-up for a median of 39.3 months (range 28.5-43.6 months). Analyses of 1- and 2-year follow-up data available for 3,157 (97.5%) and 2,952 (91.2%) patients, respectively, showed no significant differences in rates of stroke or systemic embolism (SE), major bleeding, and all-cause mortality for DOAC vs. warfarin users (1.2 vs. 1.8%/year, 0.5 vs. 1.2%/year, and 2.1 vs. 1.7%/year, respectively). Under propensity score matching, the incidence of stroke or SE (P=0.679) and all-cause death (P=0.864) remained equivalent, but the incidence of major bleeding was significantly lower (P=0.014) among DOAC than warfarin users.

CONCLUSIONS:

A high follow-up rate allowed us to obtain reliable data on the status of OAC use and therapeutic outcomes among AF patients in Japan. Warfarin and DOACs appear to yield equivalent 3-year stroke and all-cause mortality rates, but DOACs appear to reduce the risk of major bleeding.

KEYWORDS:

Atrial fibrillation; Direct oral anticoagulant; Japanese patients; Warfarin

PMID:
30078823
DOI:
10.1253/circj.CJ-18-0535
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