Safety of Direct Oral Anticoagulants and Vitamin K Antagonists in Oldest Old Patients: A Prospective Study

Rodríguez-Pascual, Carlos and Torres-Torres, Ivett and Gómez-Quintanilla, Alejandro and Ferrero-Martínez, Ana and Sharma, Jagdish and Guitian, Alba and Basalo, Maria Carmen and Montero-Magan, Marina and Vilches-Moraga, Arturo and Olcoz-Chiva, Maria Teresa and Paredes-Galán, Emilio and Rodríguez-Artalejo, Fernando (2018) Safety of Direct Oral Anticoagulants and Vitamin K Antagonists in Oldest Old Patients: A Prospective Study. Journal of the Medical Directors Association . ISSN 1525-8610

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Item Type:Article
Item Status:Live Archive

Abstract

OBJECTIVE:
The safety of direct oral anticoagulants (DOACs) in oldest old patients with nonvalvular atrial fibrillation (NVAF) in daily clinical practice has not been systematically assessed. This study examined the safety of DOACs and dicumarol (a vitamin K antagonist) in NVAF geriatric patients.

DESIGN:
Prospective study from January 2010 through June 2015, with follow-up through January 2016.

SETTING:
Geriatric medicine department at a tertiary hospital.

PARTICIPANTS:
A total of 554 outpatients, 75 years or older, diagnosed of NVAF and starting oral anticoagulation.

MEASUREMENTS:
The main outcome was bleeding, which was classified into major (including those life-threatening) and nonmajor episodes. Statistical analyses were performed with Cox regression.

RESULTS:
A total of 351 patients received DOACs and 193 dicumarol. Patients on DOACs were older, with more frequent comorbidities, mobility limitation and disability in activities of daily living, as well as higher mortality, than those treated with dicumarol. The incidence of any bleeding was 19.2/100 person-years among patients on DOACs and 13.7/100 person-years on dicumarol; corresponding figures for major bleeding were 5.2 for those on DOACs, and 3.3 for those on dicumarol. In crude analyses, hazard ratios (95% confidence intervals) for any bleeding, and for mayor bleeding in patients on DOACs vs dicumarol were 1.60 (1.04-2.44) and 2.22 (0.88-5.59), respectively. Excess risk of bleeding associated with DOACs vs dicumarol disappeared after adjustment for clinical characteristics, so that corresponding figures were 1.19 (0.68-2.08) and 1.01 (0.35-2.93). Results did not vary across subgroups of high-risk patients.

CONCLUSION:
In very old patients with NVAF, the higher risk of bleeding associated with DOACs vs dicumarol could be mostly explained by the worse clinical profile of patients receiving DOACs. Risk of bleeding was rather high, and warrants close clinical monitoring.

Keywords:elderly, atrial fibrillation, Anticoagulants, safety
Subjects:A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Science > School of Pharmacy
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ID Code:32391
Deposited On:11 Jul 2018 14:04

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