Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
Grant support
Medical Research Council - United Kingdom
British Heart Foundation - United Kingdom
PubMed
30664837
DOI
10.1016/j.amjmed.2018.12.036
PII: S0002-9343(19)30071-3
Knihovny.cz E-resources
- Keywords
- Atrial fibrillation, Cardiovascular events, Elderly, Major bleeding, NOACs, Net clinical benefit, VKAs,
- MeSH
- Anticoagulants adverse effects therapeutic use MeSH
- Administration, Oral MeSH
- Stroke etiology prevention & control MeSH
- Atrial Fibrillation complications MeSH
- Hemorrhage chemically induced MeSH
- Humans MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Vitamin K antagonists & inhibitors MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Anticoagulants MeSH
- Vitamin K MeSH
BACKGROUND: The risks of thromboembolic and hemorrhagic events in patients with atrial fibrillation both increase with age; therefore, net clinical benefit analyses of anticoagulant treatments in the elderly population are crucial to guide treatment. We evaluated the 1-year clinical outcomes with non-vitamin-K antagonist and vitamin K antagonist oral anticoagulants (NOACs vs VKAs) in elderly (≥75 years) patients with atrial fibrillation in a prospective registry setting. METHODS: Data on 3825 elderly patients were pooled from the PREFER in AF and PREFER in AF PROLONGATION registries. The primary outcome was the incidence of the net composite endpoint, including major bleeding and ischemic cardiovascular events on NOACs (n = 1556) compared with VKAs (n = 2269). RESULTS: The rates of the net composite endpoint were 6.6%/year with NOACs vs 9.1%/year with VKAs (odds ratio [OR] 0.71; 95% confidence interval [CI], 0.51-0.99; P = .042). NOAC therapy was associated with a lower rate of major bleeding compared with VKA use (OR 0.58; 95% CI, 0.38-0.90; P = .013). Ischemic events were nominally reduced too (OR 0.71; 95% CI, 0.51-1.00; P = .050). Major bleeding with NOACs was numerically lower in higher-risk patients with low body mass index (BMI; OR 0.50; 95% CI, 0.22-1.12; P = .07) or with age ≥85 years (OR 0.44; 95% CI, 0.13-1.49; P = .17). CONCLUSIONS: Our real-world data indicate that, compared with VKAs, NOAC use is associated with a better net clinical benefit in elderly patients with atrial fibrillation, primarily due to lower rates of major bleeding. Major bleeding with NOACs was numerically lower also in higher-risk patients with low BMI or age ≥85 years.
Daiichi Sankyo Europe Munich Germany
Department of Cardiovascular Sciences Campus Bio Medico University of Rome Italy
Institute of Cardiology G d'Annunzio University Chieti Italy
Institute of Cardiology G d'Annunzio University Chieti Italy; Fondazione G Monasterio Pisa Italy
Medical Faculty Pilsen of Charles University Prague Czech Republic
References provided by Crossref.org