Non-vitamin K antagonist oral anticoagulants versus warfarin in AF patients ≥ 85 years.

Publisher: Wiley Country of Publication: England NLM ID: 0245331 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2362 (Electronic) Linking ISSN: 00142972 NLM ISO Abbreviation: Eur J Clin Invest Subsets: MEDLINE

Publication: Oxford : Wiley
Original Publication: Berlin, New York, Springer-Verlag, on behalf of the European Society for Clinical Investigation.

Anticoagulants/*therapeutic use ; Atrial Fibrillation/*drug therapy ; Dabigatran/*therapeutic use ; Intracranial Hemorrhages/*epidemiology ; Ischemic Stroke/*epidemiology ; Pyrazoles/*therapeutic use ; Pyridones/*therapeutic use ; Stroke/*prevention & control ; Warfarin/*therapeutic use; Aged, 80 and over ; Antithrombins/therapeutic use ; Atrial Fibrillation/complications ; Factor Xa Inhibitors/therapeutic use ; Female ; Hemorrhage/chemically induced ; Hemorrhage/epidemiology ; Humans ; Intracranial Hemorrhages/chemically induced ; Male ; Mortality ; Propensity Score ; Stroke/etiology

Background: Atrial fibrillation (AF) prevalence and its risk of stroke rise with ageing. We aimed to investigate the outcomes of NOAC and warfarin in AF patients aged ≥ 85 years.
Methods: This is a retrospective study using Taiwan National Health Insurance Research Database. A total of 15,361 patients aged ≥ 85 years with AF on oral anticoagulants were identified. The end points included ischaemic stroke, intracranial haemorrhage (ICH), major bleeding, all-cause mortality and composite adverse events (ICH or major bleeding or all-cause mortality). Clinical outcomes were compared between each NOAC and warfarin after propensity matching.
Results: Before propensity matching, patients taking warfarin were older, more female with more comorbidities than NOACs users. After propensity matching, baseline characteristics did not differ significantly between matched subjects receiving warfarin and each NOAC. Compared to warfarin, dabigatran was associated with a lower risk of ICH (hazard ratio [HR] 0.496), mortality (HR 0.558) and adverse events (HR 0.628), while rivaroxaban was associated with a lower risk of ischaemic stroke (HR 0.781), ICH (HR 0.453), mortality (HR 0.558) and adverse events (HR 0.636). Apixaban was associated with a lower risk of mortality (HR 0.488) and adverse events (HR 0.557) compared to warfarin. (all P < .05).
Conclusion: For the efficacy, NOACs were associated with a comparable or lower risk of ischaemic stroke compared to warfarin. For adverse events, NOACs were associated with a lower risk of all-cause mortality and composite adverse events. In the elderly AF population, NOACs could be a more favourable choice for stroke prevention.
(© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

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Szu-Yuan Research Foundation of Internal Medicine; MOST 107-2314-B-075-062-MY3, MOST 108-2314-B-075-0 the Ministry of Science and Technology; MOST 108-2314-B-075-0 the Ministry of Science and Technology; V108B-015 Taipei Veterans General Hospital; V108B-027 Taipei Veterans General Hospital; V108C-090 Taipei Veterans General Hospital; V109C-042 Taipei Veterans General Hospital; V109C-186 Taipei Veterans General Hospital

Keywords: NOACs; atrial fibrillation; elderly; warfarin

0 (Anticoagulants)
0 (Antithrombins)
0 (Factor Xa Inhibitors)
0 (Pyrazoles)
0 (Pyridones)
3Z9Y7UWC1J (apixaban)
5Q7ZVV76EI (Warfarin)
I0VM4M70GC (Dabigatran)

Date Created: 20210109 Date Completed: 20211230 Latest Revision: 20211230

20240829

10.1111/eci.13488

33420738