Bibliographic Details
| Title: |
Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study. |
| Authors: |
Catalani, Filippo, Campello, Elena, Occhipinti, Giuseppina, Zorzi, Alessandro, Sartori, Marta, Zanforlini, Bruno Micael, Franchin, Alessandro, Simioni, Paolo, Sergi, Giuseppe |
| Source: |
Internal & Emergency Medicine; Oct2023, Vol. 18 Issue 7, p1941-1949, 9p |
| Abstract: |
Introduction: Direct oral anticoagulants (DOACs) are underused in the elderly, regardless the evidence in their favour in this population. Methods: We prospectively enrolled anticoagulant-naïve patients aged ≥ 75 years who started treatment with DOACs for atrial fibrillation (AF) and stratified them in older adults (aged 75–84 years) and extremely older adults (≥ 85 years). Thrombotic and hemorrhagic events were evaluated for 12 months follow-up. Results: We enrolled 518 consecutive patients. They were mostly aged 75–84 years (299 patients; 57.7%) vs. ≥ 85 years (219 patients; 42.3%). Extremely older adults showed higher incidence of all the endpoints (systemic cardioembolism [HR 3.25 (95% CI 1.71–6.18)], major bleeding [HR 2.75 (95% CI 1.77–4.27)], and clinically relevant non-major bleeding [HR 2.13 (95% CI 1.17–3.92)]) vs. older adults during the first year after starting anticoagulation. In patients aged ≥ 85 years, no difference in the aforementioned endpoints was found between those receiving on-label vs. off-label DOACs. In the extremely older adults, chronic kidney disease, polypharmacy, use of antipsychotics, and DOAC discontinuation correlated with higher rates of thrombotic events, whereas a history of bleeding, Charlson Index ≥ 6, use of reduced DOAC dose, absence of a caregiver, use of non-steroidal anti-inflammatory drugs (NSAIDs), and HAS-BLED score ≥ 3 were associated with major bleedings. Conclusions: Naïve patients aged ≥ 85 who started a DOAC for AF are at higher risk of thrombotic and bleeding events compared to those aged 75–84 years in the first year of therapy. History of bleeding, HAS-BLED score ≥ 3 and use of NSAIDs are associated with higher rates of major bleeding. [ABSTRACT FROM AUTHOR] |
|
Copyright of Internal & Emergency Medicine is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| Database: |
Complementary Index |
