Vitamin K Antagonists and Direct Oral Anticoagulants in Nonagenarian Patients With Atrial Fibrillation
Nonagenarian patients are underrepresented in clinical trials that have evaluated oral anticoagulation in patients with atrial fibrillation (AF). The aim of this study was to assess the pronostic impact of oral anticoagulation in patients with AF age ≥90 years. Retrospective multicenter study of non...
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| Veröffentlicht in: | Journal of the American Medical Directors Association 2020-03, Vol.21 (3), p.367-373.e1 |
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| creator | Raposeiras-Roubín, Sergio Alonso Rodríguez, David Camacho Freire, Santiago Jesús Abu-Assi, Emad Cobas-Paz, Rafael Rodríguez Pascual, Carlos García Comesaña, Julio González-Carrero López, Alberto Cubelos Fernández, Naiara López-Masjuán Ríos, Álvaro Cespón-Fernández, María Muñoz-Pousa, Isabel Caneiro-Queija, Berenice Rodríguez Albarrán, Adrián Castañera, Sara Álvarez Guillén, Julia Verísimo Carpintero Vara, Alberto Barreiro Pardal, Cristina Domínguez-Erquicia, Pablo Domínguez-Rodríguez, Luis Manuel Díaz Fernández, José Francisco Fernández Vázquez, Felipe Iñíguez-Romo, Andrés |
| description | Nonagenarian patients are underrepresented in clinical trials that have evaluated oral anticoagulation in patients with atrial fibrillation (AF). The aim of this study was to assess the pronostic impact of oral anticoagulation in patients with AF age ≥90 years.
Retrospective multicenter study of nonagenarian patients with AF.
A total of 1750 nonagenarian inpatients and outpatients with nonvalvular AF between January 2013 and December 2018 in 3 Spanish health areas were studied.
Patients were divided into 3 groups based on antithrombotic therapy: nonoral anticoagulants (30.5%), vitamin-K antagonists (VKAs; 28.6%), and direct oral anticoagulants (DOACs; 40.9%). During a mean follow-up of 23.6 ± 6.6 months, efficacy outcomes (death and embolic events) were evaluated using a Cox regression analysis and safety outcomes (bleeding requiring hospitalization) by competing-risk regression. Results were complemented with a propensity score matching analysis.
During follow-up, 988 patients died (56.5%), 180 had embolic events (10.3%), and 186 had major bleeding (10.6%). After multivariable adjustment, DOACs were associated with a lower risk of death and embolic events than nonanticoagulation [hazard ratio (HR) 0.75, 95% confidence interval (CI)] 0.61‒0.92), but VKAs were not (HR 0.87, 95% CI 0.72‒1.05). These results were confirmed after propensity score matching analysis. For bleeding, both DOACs and VKAs proved to be associated with a higher risk (HR for DOAC 1.43; 95% CI 0.97‒2.13; HR for VKA 1.94; 95% CI 1.31‒2.88), although findings for DOACs were not statistically significant (P = .074). For intracranial hemorrhage (ICH), only VKAs—not DOACs—presented a higher risk of ICH (HR 4.43; 95% CI 1.48‒13.31).
In nonagenarian patients with AF, DOACs led to a reduction in mortality and embolic events in comparison with nonanticoagulation. This reduction was not observed with VKAs. Although both DOACs and VKAs increased the risk of bleeding, only VKAs were associated with higher ICH rates. |
| doi_str_mv | 10.1016/j.jamda.2019.08.033 |
| format | Article |
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Retrospective multicenter study of nonagenarian patients with AF.
A total of 1750 nonagenarian inpatients and outpatients with nonvalvular AF between January 2013 and December 2018 in 3 Spanish health areas were studied.
Patients were divided into 3 groups based on antithrombotic therapy: nonoral anticoagulants (30.5%), vitamin-K antagonists (VKAs; 28.6%), and direct oral anticoagulants (DOACs; 40.9%). During a mean follow-up of 23.6 ± 6.6 months, efficacy outcomes (death and embolic events) were evaluated using a Cox regression analysis and safety outcomes (bleeding requiring hospitalization) by competing-risk regression. Results were complemented with a propensity score matching analysis.
During follow-up, 988 patients died (56.5%), 180 had embolic events (10.3%), and 186 had major bleeding (10.6%). After multivariable adjustment, DOACs were associated with a lower risk of death and embolic events than nonanticoagulation [hazard ratio (HR) 0.75, 95% confidence interval (CI)] 0.61‒0.92), but VKAs were not (HR 0.87, 95% CI 0.72‒1.05). These results were confirmed after propensity score matching analysis. For bleeding, both DOACs and VKAs proved to be associated with a higher risk (HR for DOAC 1.43; 95% CI 0.97‒2.13; HR for VKA 1.94; 95% CI 1.31‒2.88), although findings for DOACs were not statistically significant (P = .074). For intracranial hemorrhage (ICH), only VKAs—not DOACs—presented a higher risk of ICH (HR 4.43; 95% CI 1.48‒13.31).
In nonagenarian patients with AF, DOACs led to a reduction in mortality and embolic events in comparison with nonanticoagulation. This reduction was not observed with VKAs. Although both DOACs and VKAs increased the risk of bleeding, only VKAs were associated with higher ICH rates.</description><identifier>ISSN: 1525-8610</identifier><identifier>EISSN: 1538-9375</identifier><identifier>DOI: 10.1016/j.jamda.2019.08.033</identifier><identifier>PMID: 31753740</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Atrial fibrillation ; direct oral anticoagulants ; major bleeding ; nonagenarian ; stroke ; Vitamin K antagonist</subject><ispartof>Journal of the American Medical Directors Association, 2020-03, Vol.21 (3), p.367-373.e1</ispartof><rights>2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine</rights><rights>Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-6ef2cb3efb6bc17caae2e54c41f15b037ff29baa1882b9a16402701d018b7a6f3</citedby><cites>FETCH-LOGICAL-c359t-6ef2cb3efb6bc17caae2e54c41f15b037ff29baa1882b9a16402701d018b7a6f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jamda.2019.08.033$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31753740$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Raposeiras-Roubín, Sergio</creatorcontrib><creatorcontrib>Alonso Rodríguez, David</creatorcontrib><creatorcontrib>Camacho Freire, Santiago Jesús</creatorcontrib><creatorcontrib>Abu-Assi, Emad</creatorcontrib><creatorcontrib>Cobas-Paz, Rafael</creatorcontrib><creatorcontrib>Rodríguez Pascual, Carlos</creatorcontrib><creatorcontrib>García Comesaña, Julio</creatorcontrib><creatorcontrib>González-Carrero López, Alberto</creatorcontrib><creatorcontrib>Cubelos Fernández, Naiara</creatorcontrib><creatorcontrib>López-Masjuán Ríos, Álvaro</creatorcontrib><creatorcontrib>Cespón-Fernández, María</creatorcontrib><creatorcontrib>Muñoz-Pousa, Isabel</creatorcontrib><creatorcontrib>Caneiro-Queija, Berenice</creatorcontrib><creatorcontrib>Rodríguez Albarrán, Adrián</creatorcontrib><creatorcontrib>Castañera, Sara Álvarez</creatorcontrib><creatorcontrib>Guillén, Julia Verísimo</creatorcontrib><creatorcontrib>Carpintero Vara, Alberto</creatorcontrib><creatorcontrib>Barreiro Pardal, Cristina</creatorcontrib><creatorcontrib>Domínguez-Erquicia, Pablo</creatorcontrib><creatorcontrib>Domínguez-Rodríguez, Luis Manuel</creatorcontrib><creatorcontrib>Díaz Fernández, José Francisco</creatorcontrib><creatorcontrib>Fernández Vázquez, Felipe</creatorcontrib><creatorcontrib>Iñíguez-Romo, Andrés</creatorcontrib><title>Vitamin K Antagonists and Direct Oral Anticoagulants in Nonagenarian Patients With Atrial Fibrillation</title><title>Journal of the American Medical Directors Association</title><addtitle>J Am Med Dir Assoc</addtitle><description>Nonagenarian patients are underrepresented in clinical trials that have evaluated oral anticoagulation in patients with atrial fibrillation (AF). The aim of this study was to assess the pronostic impact of oral anticoagulation in patients with AF age ≥90 years.
Retrospective multicenter study of nonagenarian patients with AF.
A total of 1750 nonagenarian inpatients and outpatients with nonvalvular AF between January 2013 and December 2018 in 3 Spanish health areas were studied.
Patients were divided into 3 groups based on antithrombotic therapy: nonoral anticoagulants (30.5%), vitamin-K antagonists (VKAs; 28.6%), and direct oral anticoagulants (DOACs; 40.9%). During a mean follow-up of 23.6 ± 6.6 months, efficacy outcomes (death and embolic events) were evaluated using a Cox regression analysis and safety outcomes (bleeding requiring hospitalization) by competing-risk regression. Results were complemented with a propensity score matching analysis.
During follow-up, 988 patients died (56.5%), 180 had embolic events (10.3%), and 186 had major bleeding (10.6%). After multivariable adjustment, DOACs were associated with a lower risk of death and embolic events than nonanticoagulation [hazard ratio (HR) 0.75, 95% confidence interval (CI)] 0.61‒0.92), but VKAs were not (HR 0.87, 95% CI 0.72‒1.05). These results were confirmed after propensity score matching analysis. For bleeding, both DOACs and VKAs proved to be associated with a higher risk (HR for DOAC 1.43; 95% CI 0.97‒2.13; HR for VKA 1.94; 95% CI 1.31‒2.88), although findings for DOACs were not statistically significant (P = .074). For intracranial hemorrhage (ICH), only VKAs—not DOACs—presented a higher risk of ICH (HR 4.43; 95% CI 1.48‒13.31).
In nonagenarian patients with AF, DOACs led to a reduction in mortality and embolic events in comparison with nonanticoagulation. This reduction was not observed with VKAs. Although both DOACs and VKAs increased the risk of bleeding, only VKAs were associated with higher ICH rates.</description><subject>Atrial fibrillation</subject><subject>direct oral anticoagulants</subject><subject>major bleeding</subject><subject>nonagenarian</subject><subject>stroke</subject><subject>Vitamin K antagonist</subject><issn>1525-8610</issn><issn>1538-9375</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kMtOxCAUhonReH8CE8PSTSuUXhcuJuqocaIuvCzJgcLIpKUK1MS3lzrq0hWE_zuccz6EjihJKaHl6SpdQd9CmhHapKROCWMbaJcWrE4aVhWb0z0rkrqkZAfteb8iZELLbbTDaFWwKie7SD-bAL2x-BbPbIDlYI0PHoNt8YVxSgZ876CbMiMHWI4d2BhH_m6wsFQWnAGLHyAYNQUvJrziWYiPHZ4b4UzXxWiwB2hLQ-fV4c-5j57ml4_n18ni_urmfLZIJCuakJRKZ1IwpUUpJK0kgMpUkcucaloIwiqts0YA0LrORAO0zElWEdoSWosKSs320cn63zc3vI_KB94bL1Wcwqph9DybNm_qvCARZWtUusF7pzR_c6YH98kp4ZNgvuLfgvlkjZOaR8Gx6vinwSh61f7V_BqNwNkaUHHND6Mc9zK6kar91snbwfzb4AtAL45O</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Raposeiras-Roubín, Sergio</creator><creator>Alonso Rodríguez, David</creator><creator>Camacho Freire, Santiago Jesús</creator><creator>Abu-Assi, Emad</creator><creator>Cobas-Paz, Rafael</creator><creator>Rodríguez Pascual, Carlos</creator><creator>García Comesaña, Julio</creator><creator>González-Carrero López, Alberto</creator><creator>Cubelos Fernández, Naiara</creator><creator>López-Masjuán Ríos, Álvaro</creator><creator>Cespón-Fernández, María</creator><creator>Muñoz-Pousa, Isabel</creator><creator>Caneiro-Queija, Berenice</creator><creator>Rodríguez Albarrán, Adrián</creator><creator>Castañera, Sara Álvarez</creator><creator>Guillén, Julia Verísimo</creator><creator>Carpintero Vara, Alberto</creator><creator>Barreiro Pardal, Cristina</creator><creator>Domínguez-Erquicia, Pablo</creator><creator>Domínguez-Rodríguez, Luis Manuel</creator><creator>Díaz Fernández, José Francisco</creator><creator>Fernández Vázquez, Felipe</creator><creator>Iñíguez-Romo, Andrés</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202003</creationdate><title>Vitamin K Antagonists and Direct Oral Anticoagulants in Nonagenarian Patients With Atrial Fibrillation</title><author>Raposeiras-Roubín, Sergio ; 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The aim of this study was to assess the pronostic impact of oral anticoagulation in patients with AF age ≥90 years.
Retrospective multicenter study of nonagenarian patients with AF.
A total of 1750 nonagenarian inpatients and outpatients with nonvalvular AF between January 2013 and December 2018 in 3 Spanish health areas were studied.
Patients were divided into 3 groups based on antithrombotic therapy: nonoral anticoagulants (30.5%), vitamin-K antagonists (VKAs; 28.6%), and direct oral anticoagulants (DOACs; 40.9%). During a mean follow-up of 23.6 ± 6.6 months, efficacy outcomes (death and embolic events) were evaluated using a Cox regression analysis and safety outcomes (bleeding requiring hospitalization) by competing-risk regression. Results were complemented with a propensity score matching analysis.
During follow-up, 988 patients died (56.5%), 180 had embolic events (10.3%), and 186 had major bleeding (10.6%). After multivariable adjustment, DOACs were associated with a lower risk of death and embolic events than nonanticoagulation [hazard ratio (HR) 0.75, 95% confidence interval (CI)] 0.61‒0.92), but VKAs were not (HR 0.87, 95% CI 0.72‒1.05). These results were confirmed after propensity score matching analysis. For bleeding, both DOACs and VKAs proved to be associated with a higher risk (HR for DOAC 1.43; 95% CI 0.97‒2.13; HR for VKA 1.94; 95% CI 1.31‒2.88), although findings for DOACs were not statistically significant (P = .074). For intracranial hemorrhage (ICH), only VKAs—not DOACs—presented a higher risk of ICH (HR 4.43; 95% CI 1.48‒13.31).
In nonagenarian patients with AF, DOACs led to a reduction in mortality and embolic events in comparison with nonanticoagulation. This reduction was not observed with VKAs. Although both DOACs and VKAs increased the risk of bleeding, only VKAs were associated with higher ICH rates.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31753740</pmid><doi>10.1016/j.jamda.2019.08.033</doi></addata></record> |
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| source | Access via ScienceDirect (Elsevier) |
| subjects | Atrial fibrillation direct oral anticoagulants major bleeding nonagenarian stroke Vitamin K antagonist |
| title | Vitamin K Antagonists and Direct Oral Anticoagulants in Nonagenarian Patients With Atrial Fibrillation |
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