Arrhythmias & electrophysiology
Outcomes With Warfarin in Atrial Fibrillation: Individual Patient Data Analysis From Four Randomized Trials
Authors' conclusion
Several predictors of poor warfarin outcomes were identified. Although SD-DOACs reduced NCO across the risk spectrum, patients with low TIMI-AF scores derived modest absolute benefit. In settings with limited DOAC access, warfarin may be a reasonable option for lower-risk patients.
Study context
- Population
- Patients with atrial fibrillation enrolled in 4 pivotal randomized trials of direct oral anticoagulants (DOACs) vs warfarinpatients in 4 pivotal randomized trials · warfarin 29,272 · DOAC 29,362
- Participants
- 58,634 patients
- Comparison
- Outcomes with SD-DOACs vs warfarin were compared across risk strata.
- warfarinn = 29,272
- DOACn = 29,362
Methodological detailstrial-stratified Cox models
- Trial-stratified Cox models
Primary result
As reported in the abstract
Predictors of NCO (all-cause death, disabling or fatal stroke, or intracranial/fatal bleeding) with warfarin
- Older age, aHR
- 1.55 (95% CI 1.31-1.83)
- Male sex, aHR
- 1.30 (95% CI 1.20-1.40)
- Impaired kidney function, aHR
- 2.21 (95% CI 1.90-2.56)
- Lower body mass index, aHR
- 1.25 (95% CI 1.15-1.36)
- Vitamin K antagonist-naïve status, aHR
- 1.17 (95% CI 1.08-1.27)
- Nonparoxysmal atrial fibrillation (AF), aHR
- 1.31 (95% CI 1.19-1.44)
Further findings
| Outcome | Absolute benefit (95% CI) |
|---|---|
| NCO with SD-DOACs vs warfarin across risk strata · low-risk patients; benefit with DOACs | 0.3% (0.1%–0.6%) |
Annualized net clinical outcome (NCO) rates by TIMI-AF risk group
- Low-risk TIMI-AF
- 3.5%
- Intermediate-risk TIMI-AF
- 7.6%
- High-risk TIMI-AF
- 12.9%
- P trend<0.001
NCO with SD-DOACs vs warfarin across risk strata
- SD-DOACs reduced NCO across all risk strata
Original publication
Outcomes With Warfarin in Atrial Fibrillation: Individual Patient Data Analysis From Four Randomized Trials. JACC Adv. doi:10.
Summarised from the published abstract; every number is checked against it