Full-dose DOACs did even better against warfarin in Asian patients with atrial fibrillation

The edition in brief

COMBINE AF pooled individual data from the four pivotal DOAC-versus-warfarin trials, including 10,212 Asian patients. Compared with warfarin, standard-dose DOACs cut stroke or systemic embolism by more in Asian patients (HR 0.65) than in others (HR 0.86), and major bleeding too (0.62 vs 0.91), without the excess gastrointestinal bleeding seen in non-Asian patients. Lower doses raised stroke risk by 57% compared with standard doses in Asian patients. The finding speaks directly to the habit of under-dosing DOACs in lighter patients, common in Indian practice. STAREE randomised 9,971 people aged 70 or more without cardiovascular disease, diabetes or dementia to atorvastatin 40 mg or placebo. Over about six years, major cardiovascular events fell (HR 0.70), but disability-free survival did not change (HR 0.94, CI crossing 1). Statins in this age group prevent heart attacks and strokes; they do not keep people independent for longer. A meta-analysis of 139 heart failure trials found no difference in drug efficacy between women and men. An English cohort of 7,836 patients found lower FFR-CT values were linked to more myocardial infarction and cardiovascular death, independent of stenosis severity. The pearl covers DOAC dose-reduction criteria.