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.

3rd Medical Department Cardiology and Intensive Care Medicine Wilhelminenhospital Vienna Austria; Sigmund Freud University Medical School Vienna Austria

Daiichi Sankyo Europe Munich Germany

Department of Cardiology Medical University of Vienna Austria; 1st Department of Cardiology Poznan University of Medical Sciences Poznan Poland

Department of Cardiovascular Sciences Campus Bio Medico University of Rome Italy

Institute of Advanced Biomedical Technologies Department of Neuroscience Imaging and Clinical Sciences G d'Annunzio University Chieti Italy; Department of Clinical Sciences Lund University Malmö Sweden

Institute of Cardiology G d'Annunzio University Chieti Italy

Institute of Cardiology G d'Annunzio University Chieti Italy; Fondazione G Monasterio Pisa Italy

Institute of Cardiovascular Sciences University of Birmingham and SWBH and UHB NHS Trust Birmingham UK

Medical Faculty Pilsen of Charles University Prague Czech Republic

Am J Med. 2019 Jun;132(6):671-672. doi: 10.1016/j.amjmed.2019.01.038. PubMed

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