Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry

Akiko Chishaki, Naoko Kumagai, Naohiko Takahashi, Tetsunori Saikawa, Hiroshi Inoue, Ken Okumura, Hirotsugu Atarashi, Takeshi Yamashita, Hideki Origasa, Masayuki Sakurai, Yuichiro Kawamura, Isao Kubota, Kazuo Matsumoto, Yoshiaki Kaneko, Satoshi Ogawa, Yoshifusa Aizawa, Masaomi Chinushi, Itsuo Kodama, Eiichi Watanabe, Yukihiro KoretsuneYuji Okuyama, Akihiko Shimizu, Osamu Igawa, Shigenobu Bando, Masahiko Fukatani

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)267-273
Number of pages7
JournalThrombosis Research
Volume136
Issue number2
DOIs
Publication statusPublished - 01-08-2015

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Propensity Score
Warfarin
Atrial Fibrillation
Registries
Thromboembolism
Hemorrhage
Therapeutics
Anticoagulants
Incidence
Selection Bias

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

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. / Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry. In: Thrombosis Research. 2015 ; Vol. 136, No. 2. pp. 267-273.
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title = "Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry",
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.",
author = "Akiko Chishaki and Naoko Kumagai and Naohiko Takahashi and Tetsunori Saikawa and Hiroshi Inoue and Ken Okumura and Hirotsugu Atarashi and Takeshi Yamashita and Hideki Origasa and Masayuki Sakurai and Yuichiro Kawamura and Isao Kubota and Kazuo Matsumoto and Yoshiaki Kaneko and Satoshi Ogawa and Yoshifusa Aizawa and Masaomi Chinushi and Itsuo Kodama and Eiichi Watanabe and Yukihiro Koretsune and Yuji Okuyama and Akihiko Shimizu and Osamu Igawa and Shigenobu Bando and Masahiko Fukatani",
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language = "English",
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pages = "267--273",
journal = "Thrombosis Research",
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Chishaki, A, Kumagai, N, Takahashi, N, Saikawa, T, Inoue, H, Okumura, K, Atarashi, H, Yamashita, T, Origasa, H, Sakurai, M, Kawamura, Y, Kubota, I, Matsumoto, K, Kaneko, Y, Ogawa, S, Aizawa, Y, Chinushi, M, Kodama, I, Watanabe, E, Koretsune, Y, Okuyama, Y, Shimizu, A, Igawa, O, Bando, S & Fukatani, M 2015, 'Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry', Thrombosis Research, vol. 136, no. 2, pp. 267-273. https://doi.org/10.1016/j.thromres.2015.06.009

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 journalArticle

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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