Current use of direct oral anticoagulants for atrial fibrillation in Japan: Findings from the SAKURA AF Registry

Yasuo Okumura, Katsuaki Yokoyama, Naoya Matsumoto, Eizo Tachibana, Keiichiro Kuronuma, Koji Oiwa, Michiaki Matsumoto, Toshiaki Kojima, Shoji Hanada, Kazumiki Nomoto, Ken Arima, Fumiyuki Takahashi, Tomobumi Kotani, Yukitoshi Ikeya, Seiji Fukushima, Satoru Itoh, Kunio Kondo, Masaaki Chiku, Yasumi Ohno, Motoyuki OnikuraAtsushi Hirayama, SAKURA AF Registry Investigators the SAKURA AF Registry Investigators

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76 Citations (Scopus)


Background Large-scale investigations on the use of oral anticoagulants including direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) have not included Japanese patients. Methods We established the multicenter SAKURA AF Registry to support prospective observational research on the status of anticoagulation treatment, especially with DOAC, for AF in Japan. We enrolled 3266 AF patients treated with warfarin (n=1577) or any of 4 DOACs (n=1689) from 63 institutions (2 cardiovascular centers, 13 affiliated hospitals or community hospitals, and 48 private clinics) in the Tokyo area. Results We conducted our first analysis of the registry data, and although we found equivalent mean age between the DOAC and warfarin users (71.8±9.5 vs. 72.3±9.4 years, p=0.2117), we found a slightly lower risk of stroke (CHADS2 score of 0 or 1 [46.9% vs. 39.4%, p<0.0001]) and significantly better creatinine clearance in DOAC users (70.4±27 vs. 65.6±25.7 mL/min, p<0.0001). Importantly, we documented under-dosing in 32% of warfarin users and inappropriate-low-dosing in 19.7–27.6% of DOAC users. Conclusions Our initial analysis of the SAKURA AF Registry data clarified the real-world use of anticoagulants, which includes DOACs and warfarin in Japan. The DOAC users were at a lower risk for stroke than the warfarin users. In 20–30% of DOAC users, the dose was inappropriately reduced.

Original languageEnglish
Pages (from-to)289-296
Number of pages8
JournalJournal of Arrhythmia
Issue number4
Publication statusPublished - Aug 2017
Externally publishedYes


  • Atrial fibrillation
  • Direct oral anticoagulants
  • SAKURA AF Registry
  • Warfarin


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