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      The Use of Direct Oral Anticoagulants for Prevention of Stroke and Systemic Embolic Events in East Asian Patients with Nonvalvular Atrial Fibrillation

      , MD , 1

      Cardiovascular Innovations and Applications


      anticoagulant, direct oral anticoagulant, East Asia, stroke

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          As patients in East Asia age, the prevalence of age-related and chronic disease, including nonvalvular atrial fibrillation, may increase. Although warfarin has been the primary choice of anticoagulant for the prevention of stroke and systemic embolic events, the use of direct oral anticoagulants (DOACs) is increasing. DOACs do not require monitoring of the international normalized ratio to determine the optimal dose, and have a lower potential for food and drug interactions, improved benefit-risk profiles, and a quicker onset and offset of action relative to warfarin. The pivotal phase 3 trials for each of the DOACs – dabigatran, rivaroxaban, apixaban, and edoxaban – included at least some East Asian patients. Additionally, several clinical trials were conducted specifically for East Asian patients. This review discusses patterns and predictors of anticoagulant use in East Asian patients with nonvalvular atrial fibrillation, summarizes current guideline recommendations for East Asian patients, details the primary results demonstrating the safety and efficacy of DOACs in East Asian patients relative to non–East Asian patients, provides real-world data supporting the phase 3 testing results, and addresses the clinical profile of DOACs in East Asian populations, including patients at high risk of stroke.

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          Most cited references 52

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          The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe.

          Although atrial fibrillation (AF) is accepted as the most common sustained cardiac arrhythmia, most published epidemiologic studies focus on predominantly white populations in North America or Europe, and information on AF in nonwhite populations is scarce. The objective of this study was to undertake a systematic review of the published literature on the epidemiology of AF in other regions. Systematic literature searches (MEDLINE; 1990-2010) identified epidemiologic studies reporting on the prevalence or incidence of AF, stroke in AF, risk factors for AF, or the use of antithrombotic therapy in countries outside North America and Europe. This report presents a descriptive analysis of the data; no meta-analysis was planned. Many of the 38 articles identified were from the Far East, although Australia, New Zealand, the Middle East, and South America were also represented. The reported prevalence of AF varied among countries, with different ranges in community- and hospital-based studies (0.1%-4% and 2.8%-14%, respectively). The use of anticoagulant therapy varied widely among countries and studies, as did the reported prevalence of stroke in patients with AF (2.8%-24.2%). High-quality epidemiologic studies are clearly required to improve understanding of the worldwide burden of AF and stroke in AF. Major improvements in the provision of thromboprophylaxis are also needed in many countries, given the high proportion of untreated patients who are, hence, at risk of stroke.
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            Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation.

            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.
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              Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: a science advisory for healthcare professionals from the American Heart Association/American Stroke Association.


                Author and article information

                Cardiovascular Innovations and Applications
                Compuscript (Ireland )
                July 2018
                August 2018
                : 3
                : 2
                : 215-226
                1Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
                Author notes
                Correspondence: Chang-Sheng Ma, MD, Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, People’s Republic of China, Tel.: +86-1064456412, Fax: +86-1064456078, E-mail: chshma@ 123456vip.sina.com
                Copyright © 2018 Cardiovascular Innovations and Applications

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.



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