Effectiveness and safety of non-vitamin-K antagonist oral anticoagulants versus warfarin in atrial fibrillation patients with thrombocytopenia.
J Thromb Thrombolysis
; 47(4): 512-519, 2019 May.
Article
em En
| MEDLINE
| ID: mdl-30565148
ABSTRACT
Patients with thrombocytopenia were excluded from major clinical trials that investigated non-vitamin-K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF). The aim of this study was to evaluate the effectiveness and safety of NOAC versus warfarin in AF patients with thrombocytopenia. From 2010 to 2017, a cohort study based on electronic medical records of a multi-center healthcare provider in Taiwan and included 8239 anticoagulated AF patients (age 77.0 ± 7.3 years, 48.0% female). Patients were divided into two subgroups 7872 patients with a normal platelet count and 367 patients (4.4%) with thrombocytopenia, which was defined as a platelet count less than 100 × 103/µL. We performed Cox proportional hazard analyses to compare the risks of ischemic stroke or systemic embolism (IS/SE), major bleeding, and death between NOAC and warfarin therapies in patients with a normal platelet count and those with thrombocytopenia, respectively. In patients with a normal platelet count, NOAC therapy (n = 4904) was associated with a significantly lower risk of major bleeding, with no difference in the risk of IS/SE or death when compared with warfarin therapy (n = 2968). In patients with thrombocytopenia, NOAC therapy (n = 181) was associated with a lower tendency for major bleeding (aHR 0.45, 95% CI 0.16-1.14) with no significant difference in IS/SE (aHR 0.94, 95% CI 0.29-2.91) or death (aHR 0.95, 95% CI 0.46-1.95) when compared with warfarin therapy (n = 186). NOAC therapy is a reasonable choice for stroke prevention in AF patients with thrombocytopenia.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
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Trombocitopenia
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Vitamina K
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Anticoagulantes
Tipo de estudo:
Observational_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Thromb Thrombolysis
Assunto da revista:
ANGIOLOGIA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Taiwan