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|Title:||Dabigatran versus warfarin: Effects on ischemic and hemorrhagic strokes and bleeding in asians and non-Asians with atrial fibrillation|
Stuart J. Connolly
Li Sheng Liu
Chu Pak Lau
Sung Soon Kim
Antonio L. Dans
Ru San Tan
Jyh Hong Chen
Michael D. Ezekowitz
Paul A. Reilly
Osaka Medical Center for Cancer and Cardiovascular Diseases
Population Health Research Institute, Ontario
The University of Hong Kong
Yonsei University College of Medicine
Institut Jantung Negara Kuala Lumpur
Philippine General Hospital
National Heart Centre, Singapore
National Cheng Kung University Hospital
Nippon Boehringer Ingelheim Co., Ltd.
Jefferson Medical College
Boehringer Ingelheim Pharmaceuticals, Inc.
|Citation:||Stroke. Vol.44, No.7 (2013), 1891-1896|
|Abstract:||BACKGROUND AND PURPOSE - : Intracranial hemorrhage rates are higher in Asians than non-Asians, especially in patients receiving warfarin. This randomized evaluation of long-term anticoagulation therapy subgroup analysis assessed dabigatran etexilate (DE) and warfarin effects on stroke and bleeding rates in patients from Asian and non-Asian countries. METHODS - : There were 2782 patients (15%) from 10 Asian countries and 15 331 patients from 34 non-Asian countries. A Cox regression model, with terms for treatment, region, and their interaction was used. RESULTS - : Rates of stroke or systemic embolism in Asians were 3.06% per year on warfarin, 2.50% per year on DE 110 mg BID (DE 110), and 1.39% per year on DE 150 mg BID (DE 150); in non-Asians, the rates were 1.48%, 1.37%, and 1.06% per year with no significant treatment-by-region interactions. Hemorrhagic stroke on warfarin occurred more often in Asians than non-Asians (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.3-4.7; P=0.007), with significant reductions for DE compared with warfarin in both Asian (DE 110 versus warfarin HR, 0.15; 95% CI, 0.03-0.66 and DE 150 versus warfarin HR, 0.22; 95% CI, 0.06-0.77) and non-Asian (DE 110 versus warfarin HR, 0.37; 95% CI, 0.19-0.72 and DE 150 versus warfarin HR, 0.28; 95% CI, 0.13-0.58) patients. Major bleeding rates in Asians were significantly lower on DE (both doses) than warfarin (warfarin 3.82% per year, DE 110 2.22% per year, and DE 150 2.17% per year). CONCLUSIONS - : Hemorrhagic stroke rates were higher on warfarin in Asians versus non-Asians, despite similar blood pressure, younger age, and lower international normalized ratio values. Hemorrhagic strokes were significantly reduced by DE in both Asians and non-Asians. DE benefits were consistent across Asian and non-Asian subgroups. CLINICAL TRIAL REGISTRATION - : URL: http://www.clinicaltrials.gov. Unique identifier: NCT00262600. © 2013 American Heart Association, Inc.|
|Appears in Collections:||Scopus 2011-2015|
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