Direct oral anticoagulants vs warfarin in Asian vs non-Asian patients with atrial fibrillation: a patient-level meta-analysis from COMBINE AF.
Tze-Fan Chao, Eugene Braunwald, Michael G Palazzolo et al.
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In 30 seconds
This patient-level meta-analysis compared clinical outcomes of direct oral anticoagulants (DOACs) versus warfarin in 10,212 Asian and 61,471 non-Asian patients with atrial fibrillation. Results indicated that standard-dose DOACs significantly reduced the risks of stroke/systemic embolic events and major bleeding in Asians compared to non-Asians, with hazard ratios of 0.65 and 0.62, respectively. The study highlights the differential efficacy of anticoagulants based on race.
Key findings
- Asians had a higher adjusted risk of stroke/systemic embolic events compared to non-Asians (P < .001).
- Standard-dose DOACs reduced stroke/systemic embolic events in Asians more than in non-Asians (HR 0.65 vs HR 0.86).
- Standard-dose DOACs did not increase gastrointestinal bleeding risk in Asians, unlike in non-Asians (HR 0.92 vs HR 1.41).
- Lower-dose DOACs significantly increased the risk of stroke/systemic embolic events in Asians (HR 1.57).
Why it matters
Understanding the differences in anticoagulant efficacy and safety between Asian and non-Asian patients can guide clinicians in personalizing treatment for atrial fibrillation, potentially improving patient outcomes and minimizing risks.