What is the risk of ICH for Asian AF patients compared to whites when using VKAs?
Asian AF patients have a higher risk of ICH compared to whites when using VKAs. This has been observed in major clinical trials of NOACs, even though Asians received a lower intensity of anticoagulation with VKA. In a recent meta-analysis comprising 5 NOAC trials, the effects of NOACs vs warfarin in 1154 Asians vs non-Asians were compared. For standard-dose NOACs, the effect sizes of the primary efficacy end point (stroke and systemic embolism) and the primary safety end point (major bleeding) were greater in Asians vs non-Asians. The risk reduction in hemorrhagic stroke and gastrointestinal bleeding was also greater in Asians vs non-Asians. These data suggest that standard-dose NOACs, when compared with warfarin, were more effective and safer in Asians than in non-Asians. The efficacy and safety of low-dose NOACs, when compared with warfarin, appear similar among Asians and non-Asians.