Arrhythmias & electrophysiology
Comparison of different direct oral anticoagulant regimens in atrial fibrillation patients with high bleeding risk
Authors' conclusion
Among patients with a predominant bleeding risk but relatively low thrombosis risk, the low-dose DOAC regimen is not a more appropriate selection than standard-dose regimen.
Study context
- Population
- Atrial fibrillation (AF) patients aged 20–75 years on DOAC, CHA2DS2-VASc 1 (males) or 2 (females) and HAS-BLED ≥352.1% standard-dose
- Participants
- 964 patients
- Exposure
- Low-dose vs standard-dose DOAC regimen
- Outcome
- Ischemic stroke and major bleeding
Methodological detailsTaiwan National Health Insurance claims database
- Taiwan National Health Insurance claims database
Main finding
As reported in the abstract
Low-dose vs Standard-doseaHR
Ischemic stroke
5.13(95% CI 1.37–19.22)
Major bleeding
0.45(CI 0.12–1.67)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aHR (CI) | |
|---|---|---|
| Systemic thromboembolism | 3.14 (1.05–9.37) | |
| 0.10.31310Adjusted hazard ratio (log scale) |
Other hemorrhage and CV death
- Similar between the 2 dose groups
Safety
| Outcome | aHR (CI) | |
|---|---|---|
| Major bleeding | 0.45 (0.12–1.67) | |
| 0.10.31310Adjusted hazard ratio (log scale) |
Original publication
Comparison of different direct oral anticoagulant regimens in atrial fibrillation patients with high bleeding risk. Heart Rhythm. Published 22 January 2024. doi:10.
Summarised from the published abstract; every number is checked against it