COMPARATIVE EFFECTIVENESS OF INDIVIDUAL NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE: A BINATIONAL POPULATION-BASED COHORT STUDY
Author(s)
Sunyeup Kim, BSc1, Beomseok Jeong, BSc1, Jaewon Cheon, BSc1, Masao Iwagami, MD, MPH, PhD2, Seungwon Lee, MD, PhD1.
1Sungkyunkwan University, Suwon, Korea, Republic of, 2Tsukuba University, Tsukuba, Japan.
1Sungkyunkwan University, Suwon, Korea, Republic of, 2Tsukuba University, Tsukuba, Japan.
OBJECTIVES: To compare the clinical effectivenessof non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients with atrial fibrillation (AF) and metabolic dysfunction-associated steatotic liver disease (MASLD), this study evaluated the risk of ischemic stroke by analyzing large-scale, nationwide health screening data from East Asian populations.
METHODS: This study used binational, population-based cohorts from South Korea (discovery cohort; National Health Insurance Service) and Japan (validation cohort; JMDC). Patients with AF and MASLD who initiated warfarin or NOACs between January 1, 2009 and December 31, 2023 were included. Patients were categorized into five groups according to their first-line anticoagulant prescription: warfarin, apixaban, dabigatran, rivaroxaban, or edoxaban. Hazard ratios (HRs) for the incidence of ischemic strokewere estimated using Cox proportional hazards models, with adjustment for metabolic and clinical covariates.
RESULTS: In the Korean cohort, 8,627 patients experienced 850 stroke events. Compared with warfarin, adjusted hazard ratios were significantly lower for apixaban (HR 0.73, 95% CI 0.58-0.93), edoxaban (HR 0.66, 95% CI 0.52-0.84), and rivaroxaban (HR 0.72, 95% CI 0.58-0.89), whereas dabigatran showed a non-significant reduction in stroke risk (HR 0.79, 95% CI 0.59-1.05). In the Japanese cohort, 4,184 patients experienced 337 stroke events. All NOACs were associated with a significantly lower risk of stroke compared with warfarin: apixaban (HR 0.59, 95% CI 0.42-0.83), dabigatran (HR 0.64, 95% CI 0.43-0.95), edoxaban (HR 0.50, 95% CI 0.36-0.69), and rivaroxaban (HR 0.67, 95% CI 0.50-0.91).
CONCLUSIONS: In real-world practice, initiation of NOAC therapy was associated with a lower risk of stroke compared with warfarin in patients with AF and MASLD, with edoxaban showing the lowest stroke risk in terms of point estimates. These findings were consistently observed at the national level across two independent East Asian population-based cohorts.
METHODS: This study used binational, population-based cohorts from South Korea (discovery cohort; National Health Insurance Service) and Japan (validation cohort; JMDC). Patients with AF and MASLD who initiated warfarin or NOACs between January 1, 2009 and December 31, 2023 were included. Patients were categorized into five groups according to their first-line anticoagulant prescription: warfarin, apixaban, dabigatran, rivaroxaban, or edoxaban. Hazard ratios (HRs) for the incidence of ischemic strokewere estimated using Cox proportional hazards models, with adjustment for metabolic and clinical covariates.
RESULTS: In the Korean cohort, 8,627 patients experienced 850 stroke events. Compared with warfarin, adjusted hazard ratios were significantly lower for apixaban (HR 0.73, 95% CI 0.58-0.93), edoxaban (HR 0.66, 95% CI 0.52-0.84), and rivaroxaban (HR 0.72, 95% CI 0.58-0.89), whereas dabigatran showed a non-significant reduction in stroke risk (HR 0.79, 95% CI 0.59-1.05). In the Japanese cohort, 4,184 patients experienced 337 stroke events. All NOACs were associated with a significantly lower risk of stroke compared with warfarin: apixaban (HR 0.59, 95% CI 0.42-0.83), dabigatran (HR 0.64, 95% CI 0.43-0.95), edoxaban (HR 0.50, 95% CI 0.36-0.69), and rivaroxaban (HR 0.67, 95% CI 0.50-0.91).
CONCLUSIONS: In real-world practice, initiation of NOAC therapy was associated with a lower risk of stroke compared with warfarin in patients with AF and MASLD, with edoxaban showing the lowest stroke risk in terms of point estimates. These findings were consistently observed at the national level across two independent East Asian population-based cohorts.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH181
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), STA: Personalized & Precision Medicine