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Effectiveness and safety of non-vitamin-K antagonist oral anticoagulants versus warfarin in atrial fibrillation patients with thrombocytopenia

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Abstract

Patients with thrombocytopenia were excluded from major clinical trials that investigated non-vitamin-K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF). The aim of this study was to evaluate the effectiveness and safety of NOAC versus warfarin in AF patients with thrombocytopenia. From 2010 to 2017, a cohort study based on electronic medical records of a multi-center healthcare provider in Taiwan and included 8239 anticoagulated AF patients (age 77.0 ± 7.3 years, 48.0% female). Patients were divided into two subgroups: 7872 patients with a normal platelet count and 367 patients (4.4%) with thrombocytopenia, which was defined as a platelet count less than 100 × 103/µL. We performed Cox proportional hazard analyses to compare the risks of ischemic stroke or systemic embolism (IS/SE), major bleeding, and death between NOAC and warfarin therapies in patients with a normal platelet count and those with thrombocytopenia, respectively. In patients with a normal platelet count, NOAC therapy (n = 4904) was associated with a significantly lower risk of major bleeding, with no difference in the risk of IS/SE or death when compared with warfarin therapy (n = 2968). In patients with thrombocytopenia, NOAC therapy (n = 181) was associated with a lower tendency for major bleeding (aHR 0.45, 95% CI 0.16–1.14) with no significant difference in IS/SE (aHR 0.94, 95% CI 0.29–2.91) or death (aHR 0.95, 95% CI 0.46–1.95) when compared with warfarin therapy (n = 186). NOAC therapy is a reasonable choice for stroke prevention in AF patients with thrombocytopenia.

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Acknowledgements

The authors thank the statistical assistance and wish to acknowledge the support of the Maintenance Project of the Center for Big Data Analytics and Statistics (Grant CLRPG3D0044) at Chang Gung Memorial Hospital for study design and monitor, data analysis and interpretation. This study is based in part on data from the Chang Gung Research Database provided by Chang Gung Memorial Hospital. The interpretation and conclusions contained herein do not represent the position of Chang Gung Memorial Hospital.

Funding

This work was funded by research grants from the Chang Gung Memorial Hospital, Linkou, Taiwan (CORPG3G0271, CMRPG3E2101, CMRPG3G2031, CLRPG3D0045).

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Authors and Affiliations

  1. Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

    Chun-Li Wang, Victor Chien-Chia Wu, Cheng-Hung Lee, Pao-Hsien Chu, Ming-Shien Wen & Shang-Hung Chang

  2. College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chun-Li Wang, Victor Chien-Chia Wu, Cheng-Hung Lee, Chang-Fu Kuo, Pao-Hsien Chu, Shao-Wei Chen, Ming-Shien Wen & Shang-Hung Chang

  3. Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

    Chang-Fu Kuo & Lai-Chu See

  4. Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK

    Chang-Fu Kuo

  5. Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

    Yu-Ling Chen & Shang-Hung Chang

  6. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

    Shao-Wei Chen

  7. Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Lai-Chu See

  8. Biostatstics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan

    Lai-Chu See

  9. Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan

    Shang-Hung Chang

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  1. Chun-Li Wang
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Wang, CL., Wu, V.CC., Lee, CH. et al. Effectiveness and safety of non-vitamin-K antagonist oral anticoagulants versus warfarin in atrial fibrillation patients with thrombocytopenia. J Thromb Thrombolysis 47, 512–519 (2019). https://doi.org/10.1007/s11239-018-1792-1

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