Use of factor Xa inhibitors tied to risk of lung injury in atrial fibrillation: JAMA

The risk, however, was found to be "quite small" and should not dissuade the first-line use of FXa inhibitors for stroke prevention.

In clinical trials and clinical practice, the use of non–vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation patients have found to be at least as effective in the prevention of stroke as vitamin K antagonists and associated with a lower risk of significant bleeding (except for dabigatran and rivaroxaban) than vitamin K antagonists (e.g., warfarin). Current international guidelines have recommended using NOACs as a safe, effective and more convenient substitute to warfarin for stroke prevention among NVAF patients.

Various NOACs have been shown to have lower bleeding risk than warfarin. Still, there are emerging concerns from pharmacovigilance analyses and case reports of a possible risk of interstitial lung disease (ILD) tied to NOAC use.

Against the above background, Yi-Hsin Chan, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, and colleagues aimed to evaluate the risk of incident ILD associated with OACs use in patients with nonvalvular atrial fibrillation.

In the nationwide retrospective cohort study, the authors used data from a database in Taiwan. The study included patients with NVAF who did not have any preexisting lung disease and received oral anticoagulants. Patients were followed up from the drug index date till the onset of death, ILD, or the study's end, whichever happened first.

Patients with nonvalvular AF were treated with FXa inhibitors, dabigatran, or warfarin.

The study led to the following findings:

• Among the 106 044 patients included in the study, 60.9% received FXa inhibitors (apixban [n = 15 386], edoxaban [n = 12 413], and rivaroxaban [n = 36 756]), 21.2% received dabigatran, and 17.9% received warfarin at baseline.
• The FXa inhibitors were tied to a higher risk of incident ILD (0.29 vs 0.17 per 100 patient-years). In contrast, dabigatran was associated with a nonsignificant difference in risk of incident ILD compared with warfarin (reference) after PSSW.
• The higher risk of incident ILD for FXa inhibitors vs warfarin was consistent with several high-risk subgroups.

"Our findings showed that FXa inhibitors are associated with lung injury among NVAF who were treated with oral anticoagulants," the authors wrote in their study. "Physicians should be vigilant in monitoring for any potential adverse outcomes for the lungs associated with these drugs."

Reference:

Chan Y, Chao T, Chen S, et al. Development of Interstitial Lung Disease Among Patients With Atrial Fibrillation Receiving Oral Anticoagulants in Taiwan. JAMA Netw Open. 2022;5(11):e2243307. doi:10.1001/jamanetworkopen.2022.43307