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NOAC treatment effective, safe for underweight nonvalvular atrial fibrillation patients
  • By Lee Han-soo
  • Published 2019.03.19 13:36
  • Updated 2019.03.19 15:44
  • comments 0

Researchers at Seoul National University Hospital have found that non-vitamin K oral anticoagulant (NOAC) is effective and safe in treating underweight nonvalvular atrial fibrillation patients, the hospital said Tuesday.

Professors Choi Eue-keun (left) and Lee So-ryoung of Seoul National University Hospital

The team, led by Professors Choi Eue-keun and Lee So-ryoung, came to such a conclusion after comparing recently developed anticoagulant NOAC against and traditional drug warfarin on nonvalvular atrial fibrillation patients with low body weight.

The researchers’ surveyed 14,013 patients prescribed with NOAC and 7,576 patients described with warfarin, who were all underweight (less than 60 kg) and suffering from nonvalvular atrial fibrillation, registered in the National Health Insurance Service data from 2014 to 2016

The team compared the safety and efficacy of six factors -- ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, hospitalization due to major hemorrhage, death from all causes, and composite outcome indicators.

At 18 months of follow-up, compared to warfarin, NOAC decreased ischemic stroke by 41 percent, intracranial hemorrhage by 45 percent, hospitalization due to major bleeding by 30 percent, and death from all causes by 30 percent. The composite outcome indicators were also excellent compared to warfarin.

The underweight situation is one of the factors that indicate the vulnerability of patients, as low body weight in nonvalvular atrial fibrillation patients can increase the risk of bleeding when prescribed with oral anticoagulants.

The study showed consistent results as the incidence of bleeding and stroke was higher in patients under 50 kg, which was about 30 percent of the patient group, compared with patients weighing 50 to 60 kg. Nevertheless, patients with less than 50 kg had a consistently lower risk compared to warfarin.

“Particular attention should be paid to low-weight patients because high-dose prescriptions that do not meet their specific dosage increase the risk of bleeding,” Professor Lee said. “Also, it is best for efficacy and safety to prescribe according to medicine capacity label rather than indiscreet low dose prescription.”

This study confirms that NOAC is effective and safe for stroke prevention in treating nonvalvular atrial fibrillation patients with low body weight, she added.

Professor Choi also said, “The hospital’s study was the largest research for nonvalvular atrial fibrillation patients with low body weight in the world. Therefore, it will become an important guide for anticoagulation therapy in nonvalvular atrial fibrillation patients with low body fat, which is relatively common in Asians.”

The research will also serve as a useful guide in the treatment guidelines for nonvalvular atrial fibrillation patients with low body fat who are more vulnerable to bleeding, Choi added.


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