Different NOAC choices for Japanese, non-Asian patients with AFib

Last Updated: 2016-11-24

By Reuters Staff

NEW YORK (Reuters Health) - The choice of non-vitamin K antagonist oral anticoagulant (NOAC) for Japanese patients with non-valvular atrial fibrillation may differ from that for non-Asians, researchers from Japan report.

Based on clinical trial results, the Camm chart was developed to help physicians choose the best available NOAC in light of the patient's condition. This chart may not apply to Japanese patients, according to Dr. Ken Okumura from Saiseikai Kumamoto Hospital Cardiovascular Center in Kumamoto and colleagues.

The researchers present a modified chart, based on their review of dabigatran, rivaroxaban, apixaban, and edoxaban, in a report online October 7 in Clinical Cardiology.

In general, they note, the incidence of stroke while on anticoagulant therapy is higher in Asians than in non-Asians, and the reduction in major bleeding associated with NOACs versus warfarin is greater among Asians than among non-Asians.

Based on findings from Japanese phase 3 clinical trials, the researchers suggest several considerations for Japanese patients:

* Rivaroxaban should be withheld from patients with a high risk of bleeding; the other NOACs should be used for these patients.

* Dabigatran is the best choice for patients with a high risk of ischemic stroke and a low risk of bleeding; rivaroxaban is another alternative for these patients.

* Rivaroxaban and edoxaban, followed by apixaban, are recommended for patients with a previous stroke.

* Rivaroxaban may be best for patients with coronary artery disease, prior myocardial infarction, or a high risk of acute coronary syndrome; dabigatran and apixaban are not recommended for these patients.

* Dabigatran is not recommended for patients with gastrointestinal disorders, while apixaban or rivaroxaban is preferred for patients with a history of recent gastrointestinal bleeding or a high risk for gastrointestinal bleeding.

* Apixaban and rivaroxaban are the best choices for patients with renal impairment.

All four authors report having various relationships with several manufacturers of NOACs.

Bayer Yakuhin, Ltd. funded the writing and editorial support for this report.

Dr. Okumura did not respond to a request for comments.

SOURCE: http://bit.ly/2gjk2SK

Clin Cardiol 2016.