Abstract
Introduction Recently, direct-acting oral anticoagulants (DOACs) have been introduced, with increasing use in patients with non-valvular atrial fibrillation (NVAF). However, warfarin continues to be widely used and the benefits and risks of warfarin in NVAF patients warrant closer inspection. Materials and Methods Thromboembolism, major hemorrhage, and total and cardiovascular mortalities were analyzed in 7,406 NVAF patients in the J-RHYTHM Registry from January to July 2009, prior to DOAC introduction. Propensity score matching analysis was performed to reduce the differences in clinical characteristics between non-anticoagulant (n = 1002) and warfarin (n = 6404) cohorts to reassess warfarin outcomes over 2 years. Results The incidence of thromboembolism was significantly greater in the non-anticoagulant cohort (3.0%) than in the warfarin cohort (1.5%, P < 0.001) with less frequent major hemorrhage in the non-anticoagulant cohort (0.8%) than in the warfarin cohort (2.1%, P = 0.009). Using propensity score matching, new subsets (n = 896 each) were obtained, with matching of the clinical characteristics between warfarin and non-anticoagulant subsets. The warfarin subset had lower risk factors compared with the total warfarin cohort. The incidence of thromboembolism was higher in the non-anticoagulant subset (2.9%) than in the warfarin subset (0.7%, P < 0.001). However, major hemorrhage was not significantly different between the two subsets. Conclusions Although warfarin was associated with a significantly higher incidence of hemorrhage in the unmatched cohorts, propensity score matching revealed that warfarin reduced thromboembolism without a significant increase in hemorrhage in the matched subsets with lower risks. Propensity score matching reduced selection bias and provided rational comparisons although it had indwelling limitations.
| Original language | English |
|---|---|
| Pages (from-to) | 267-273 |
| Number of pages | 7 |
| Journal | Thrombosis Research |
| Volume | 136 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 01-08-2015 |
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All Science Journal Classification (ASJC) codes
- Hematology
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Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry. / Chishaki, Akiko; Kumagai, Naoko; Takahashi, Naohiko; Saikawa, Tetsunori; Inoue, Hiroshi; Okumura, Ken; Atarashi, Hirotsugu; Yamashita, Takeshi; Origasa, Hideki; Sakurai, Masayuki; Kawamura, Yuichiro; Kubota, Isao; Matsumoto, Kazuo; Kaneko, Yoshiaki; Ogawa, Satoshi; Aizawa, Yoshifusa; Chinushi, Masaomi; Kodama, Itsuo; Watanabe, Eiichi; Koretsune, Yukihiro; Okuyama, Yuji; Shimizu, Akihiko; Igawa, Osamu; Bando, Shigenobu; Fukatani, Masahiko.
In: Thrombosis Research, Vol. 136, No. 2, 01.08.2015, p. 267-273.Research output: Contribution to journal › Article
TY - JOUR
T1 - Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry
AU - Chishaki, Akiko
AU - Kumagai, Naoko
AU - Takahashi, Naohiko
AU - Saikawa, Tetsunori
AU - Inoue, Hiroshi
AU - Okumura, Ken
AU - Atarashi, Hirotsugu
AU - Yamashita, Takeshi
AU - Origasa, Hideki
AU - Sakurai, Masayuki
AU - Kawamura, Yuichiro
AU - Kubota, Isao
AU - Matsumoto, Kazuo
AU - Kaneko, Yoshiaki
AU - Ogawa, Satoshi
AU - Aizawa, Yoshifusa
AU - Chinushi, Masaomi
AU - Kodama, Itsuo
AU - Watanabe, Eiichi
AU - Koretsune, Yukihiro
AU - Okuyama, Yuji
AU - Shimizu, Akihiko
AU - Igawa, Osamu
AU - Bando, Shigenobu
AU - Fukatani, Masahiko
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Introduction Recently, direct-acting oral anticoagulants (DOACs) have been introduced, with increasing use in patients with non-valvular atrial fibrillation (NVAF). However, warfarin continues to be widely used and the benefits and risks of warfarin in NVAF patients warrant closer inspection. Materials and Methods Thromboembolism, major hemorrhage, and total and cardiovascular mortalities were analyzed in 7,406 NVAF patients in the J-RHYTHM Registry from January to July 2009, prior to DOAC introduction. Propensity score matching analysis was performed to reduce the differences in clinical characteristics between non-anticoagulant (n = 1002) and warfarin (n = 6404) cohorts to reassess warfarin outcomes over 2 years. Results The incidence of thromboembolism was significantly greater in the non-anticoagulant cohort (3.0%) than in the warfarin cohort (1.5%, P < 0.001) with less frequent major hemorrhage in the non-anticoagulant cohort (0.8%) than in the warfarin cohort (2.1%, P = 0.009). Using propensity score matching, new subsets (n = 896 each) were obtained, with matching of the clinical characteristics between warfarin and non-anticoagulant subsets. The warfarin subset had lower risk factors compared with the total warfarin cohort. The incidence of thromboembolism was higher in the non-anticoagulant subset (2.9%) than in the warfarin subset (0.7%, P < 0.001). However, major hemorrhage was not significantly different between the two subsets. Conclusions Although warfarin was associated with a significantly higher incidence of hemorrhage in the unmatched cohorts, propensity score matching revealed that warfarin reduced thromboembolism without a significant increase in hemorrhage in the matched subsets with lower risks. Propensity score matching reduced selection bias and provided rational comparisons although it had indwelling limitations.
AB - Introduction Recently, direct-acting oral anticoagulants (DOACs) have been introduced, with increasing use in patients with non-valvular atrial fibrillation (NVAF). However, warfarin continues to be widely used and the benefits and risks of warfarin in NVAF patients warrant closer inspection. Materials and Methods Thromboembolism, major hemorrhage, and total and cardiovascular mortalities were analyzed in 7,406 NVAF patients in the J-RHYTHM Registry from January to July 2009, prior to DOAC introduction. Propensity score matching analysis was performed to reduce the differences in clinical characteristics between non-anticoagulant (n = 1002) and warfarin (n = 6404) cohorts to reassess warfarin outcomes over 2 years. Results The incidence of thromboembolism was significantly greater in the non-anticoagulant cohort (3.0%) than in the warfarin cohort (1.5%, P < 0.001) with less frequent major hemorrhage in the non-anticoagulant cohort (0.8%) than in the warfarin cohort (2.1%, P = 0.009). Using propensity score matching, new subsets (n = 896 each) were obtained, with matching of the clinical characteristics between warfarin and non-anticoagulant subsets. The warfarin subset had lower risk factors compared with the total warfarin cohort. The incidence of thromboembolism was higher in the non-anticoagulant subset (2.9%) than in the warfarin subset (0.7%, P < 0.001). However, major hemorrhage was not significantly different between the two subsets. Conclusions Although warfarin was associated with a significantly higher incidence of hemorrhage in the unmatched cohorts, propensity score matching revealed that warfarin reduced thromboembolism without a significant increase in hemorrhage in the matched subsets with lower risks. Propensity score matching reduced selection bias and provided rational comparisons although it had indwelling limitations.
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U2 - 10.1016/j.thromres.2015.06.009
DO - 10.1016/j.thromres.2015.06.009
M3 - Article
VL - 136
SP - 267
EP - 273
JO - Thrombosis Research
JF - Thrombosis Research
SN - 0049-3848
IS - 2
ER -