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Title: | Dabigatran versus warfarin: Effects on ischemic and hemorrhagic strokes and bleeding in asians and non-Asians with atrial fibrillation |
Authors: | Masatsugu Hori Stuart J. Connolly Jun Zhu Li Sheng Liu Chu Pak Lau Prem Pais Denis Xavier Sung Soon Kim Razali Omar Antonio L. Dans Ru San Tan Jyh Hong Chen Supachai Tanomsup Mitsunori Watanabe Masahide Koyanagi Michael D. Ezekowitz Paul A. Reilly Lars Wallentin Salim Yusuf Osaka Medical Center for Cancer and Cardiovascular Diseases Population Health Research Institute, Ontario Fuwai Hospital The University of Hong Kong Research Institute Yonsei University College of Medicine Institut Jantung Negara Kuala Lumpur Philippine General Hospital National Heart Centre, Singapore National Cheng Kung University Hospital Mahidol University Nippon Boehringer Ingelheim Co., Ltd. Jefferson Medical College Boehringer Ingelheim Pharmaceuticals, Inc. Akademiska Sjukhuset |
Keywords: | Medicine;Nursing |
Issue Date: | 1-Jul-2013 |
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. |
URI: | https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84879962384&origin=inward http://repository.li.mahidol.ac.th/dspace/handle/123456789/32284 |
ISSN: | 15244628 00392499 |
Appears in Collections: | Scopus 2011-2015 |
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