Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials
Abstract Background To explore differences in outcomes between dose‐adjusted vitamin K antagonists (VKAs) “new starters” and “switchers” in patients with nonvalvular atrial fibrillation (AF). Methods A post hoc analysis was performed to assess the outcome differences between VKA “new starters” and “...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-12-01
|
| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/joa3.12255 |
| _version_ | 1818609943312334848 |
|---|---|
| author | Ying Bai Alena Shantsila Gregory Y. H. Lip |
| author_facet | Ying Bai Alena Shantsila Gregory Y. H. Lip |
| author_sort | Ying Bai |
| collection | DOAJ |
| description | Abstract Background To explore differences in outcomes between dose‐adjusted vitamin K antagonists (VKAs) “new starters” and “switchers” in patients with nonvalvular atrial fibrillation (AF). Methods A post hoc analysis was performed to assess the outcome differences between VKA “new starters” and “switchers” in AF patients using pooled individual patient data of AMADEUS and BOREALIS trials. Results A total of 4169 AF patients were included in the present analysis, which included 1383 “VKA new starters” and 2786 “VKA switchers”. VKA new starters had higher crude rates of all‐cause mortality (P = .035) and cardiovascular death (P = .047) compared to switchers. On multivariable Cox regression analysis, both “new starters” and “switchers” showed nonsignificant trends for different risks of stroke/systemic thromboembolism (SE) (hazard ratio (HR): 1.66, 95%CI: 0.95‐2.90, P = .08), major bleeding (HR: 1.25, 95% CI: 0.73‐2.16, P = .42), and all‐cause death (HR: 1.09, 95% CI: 0.75‐1.57, P = .65). On Kaplan‐Meier analysis, both groups had similar risks of stroke/systemic embolism (P = .09), major bleeding (P = .28), and all‐cause death (P = .06). Conclusions In this post hoc analysis of clinical trial patients with AF, “new starters” and “switchers” for VKA initiation had nonstatistically significant rates of trial‐adjudicated thromboembolism, major bleeding, and all‐cause mortality. |
| first_indexed | 2024-12-16T15:06:34Z |
| format | Article |
| id | doaj.art-fba29c9386a842f3b72f63f5d86efd04 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-12-16T15:06:34Z |
| publishDate | 2019-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-fba29c9386a842f3b72f63f5d86efd042022-12-21T22:27:07ZengWileyJournal of Arrhythmia1880-42761883-21482019-12-0135681582010.1002/joa3.12255Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trialsYing Bai0Alena Shantsila1Gregory Y. H. Lip2Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United KingdomLiverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United KingdomLiverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United KingdomAbstract Background To explore differences in outcomes between dose‐adjusted vitamin K antagonists (VKAs) “new starters” and “switchers” in patients with nonvalvular atrial fibrillation (AF). Methods A post hoc analysis was performed to assess the outcome differences between VKA “new starters” and “switchers” in AF patients using pooled individual patient data of AMADEUS and BOREALIS trials. Results A total of 4169 AF patients were included in the present analysis, which included 1383 “VKA new starters” and 2786 “VKA switchers”. VKA new starters had higher crude rates of all‐cause mortality (P = .035) and cardiovascular death (P = .047) compared to switchers. On multivariable Cox regression analysis, both “new starters” and “switchers” showed nonsignificant trends for different risks of stroke/systemic thromboembolism (SE) (hazard ratio (HR): 1.66, 95%CI: 0.95‐2.90, P = .08), major bleeding (HR: 1.25, 95% CI: 0.73‐2.16, P = .42), and all‐cause death (HR: 1.09, 95% CI: 0.75‐1.57, P = .65). On Kaplan‐Meier analysis, both groups had similar risks of stroke/systemic embolism (P = .09), major bleeding (P = .28), and all‐cause death (P = .06). Conclusions In this post hoc analysis of clinical trial patients with AF, “new starters” and “switchers” for VKA initiation had nonstatistically significant rates of trial‐adjudicated thromboembolism, major bleeding, and all‐cause mortality.https://doi.org/10.1002/joa3.12255new starterswitchervitamin K antagonists |
| spellingShingle | Ying Bai Alena Shantsila Gregory Y. H. Lip Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials Journal of Arrhythmia new starter switcher vitamin K antagonists |
| title | Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials |
| title_full | Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials |
| title_fullStr | Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials |
| title_full_unstemmed | Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials |
| title_short | Differences in outcomes between oral anticoagulation “new starters” and “switchers” in patients with nonvalvular atrial fibrillation: A pooled analysis of the AMADEUS and BOREALIS trials |
| title_sort | differences in outcomes between oral anticoagulation new starters and switchers in patients with nonvalvular atrial fibrillation a pooled analysis of the amadeus and borealis trials |
| topic | new starter switcher vitamin K antagonists |
| url | https://doi.org/10.1002/joa3.12255 |
| work_keys_str_mv | AT yingbai differencesinoutcomesbetweenoralanticoagulationnewstartersandswitchersinpatientswithnonvalvularatrialfibrillationapooledanalysisoftheamadeusandborealistrials AT alenashantsila differencesinoutcomesbetweenoralanticoagulationnewstartersandswitchersinpatientswithnonvalvularatrialfibrillationapooledanalysisoftheamadeusandborealistrials AT gregoryyhlip differencesinoutcomesbetweenoralanticoagulationnewstartersandswitchersinpatientswithnonvalvularatrialfibrillationapooledanalysisoftheamadeusandborealistrials |