Real-world outcomes of anticoagulant prescription in anticoagulant-naïve octogenarian patients with non-valvular atrial fibrillation
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Abstract
Background and objectives: The clinical practice of anticoagulation in anticoagulant-naïve octogenarians with non-valvular atrial fibrillation (NVAF) has not been established in a real-world setting. We aimed to investigate the real-world prescription for anticoagulation and to compare the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin vs. no anticoagulation in anticoagulant-naïve octogenarian NVAF patients.
Subjects and methods: From January 1, 2013 to August 31, 2015, we identified 89 consecutive newly detected NVAF patients aged ≥80 years. We retrospectively reviewed medical records until May 31, 2017 according to the differences in anticoagulation prescription (no anticoagulation, 39 patients; NOACs, 17; warfarin, 33). The efficacy outcome was stroke or systemic embolism. The safety outcome was total and major bleeding.
Results: Stroke incidence did not differ significantly among the prescriptions (no anticoagulation, 2.41; NOACs, 3.55; and warfarin, 1.28 per 100 patient-years). Considerable incidence of major bleeding was observed in the anticoagulation groups (no anticoagulation, no events; NOACs, 12.11; and warfarin, 4.30 per 100 patient-years, p = 0.570). Total bleeding tended to be high in the NOAC and warfarin groups compared to no anticoagulation (no anticoagulation, 1.21; NOACs, 20.91; warfarin, 10.76 per 100 patient-years, p = 0.054). In the multivariable Cox proportional hazard model, previous bleeding history, warfarin and NOACs treatment were significant predictors for total bleeding.
Conclusion: The occurrence of total and major bleeding was excessively high in the anticoagulation groups (NOACs or warfarin) compared to the no anticoagulation group. Future study is required to optimize anticoagulant regimen in octogenarian subjects.
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Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, et al. (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285: 2370-2375. Link: https://bit.ly/3dDhvkb
Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 22: 983-988. Link: https://bit.ly/2Uds4mi
Kannel WB, Wolf PA, Benjamin EJ, Levy D (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82: 2N-9N. Link: https://bit.ly/3eQMdGS .
Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137: 263-272. Link: https://bit.ly/3eS1F5x
January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, et al. (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64: e1-76.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, et al. (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37: 2893-2962. Link: https://bit.ly/3cyjepH
Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146: 857-867. Link: https://bit.ly/3dGgN5S
Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, et al. (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 370: 493-503. Link: https://bit.ly/2Y8fUMM
Singer DE, Chang Y, Fang MC, Borowsky LH, Pomernacki NK, et al. (2009) The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med 151: 297-305. Link: https://bit.ly/3gRaluV
Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S (2007) Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 115: 2689-2696. Link: https://bit.ly/3dGhf44
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, et al. (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361: 1139-1151. Link: https://bit.ly/2Bth8KT
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, et al. (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365: 883-891. Link: https://bit.ly/2zVIOIb
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, et al. (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365: 981-992. Link: https://bit.ly/2AHDVT3
Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, et al. (2013) Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 369: 2093-2104. Link: https://bit.ly/3gWxNa3
Sardar P, Chatterjee S, Chaudhari S, Lip GY (2104) New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Geriatr Soc 62: 857-864. Link: https://bit.ly/2ADQX3Y
Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, et al. (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383: 955-962. Link: https://bit.ly/3gZMFUY
Wong KS, Hu DY, Oomman A, Tan RS, Patel MR, et al. (2014) Rivaroxaban for stroke prevention in East Asian patients from the ROCKET AF trial. Stroke 45: 1739-1747. Link: https://bit.ly/3dzKzt6
Hori M, Connolly SJ, Zhu J, Liu LS, Lau CP, et al. (2013) Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation. Stroke 44: 1891-1896. Link: https://bit.ly/308vlHz
Kwon CH, Kim M, Kim J, Nam GB, Choi KJ, et al. (2016) Real-world comparison of non-vitamin K antagonist oral anticoagulants and warfarin in Asian octogenarian patients with atrial fibrillation. J Geriatr Cardiol 13: 566-572. Link: https://bit.ly/2zaKmO2
January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, et al. (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 130: 2071-2104. Link: https://bit.ly/30aeuE7
Group JCSJW (2010) Guidelines for pharmacotherapy of atrial fibrillation (JCS 2008): digest version. Circ J 74: 2479-2500. Link: https://bit.ly/2XzD1ke
Choi WS, Kim JH, Jang SY, Park SH, Bae MH, et al. (2016) Optimal International Normalized Ratio for Warfarin Therapy in Elderly Korean Patients with Non-Valvular Atrial Fibrillation. Int J Arrhythm 17: 167-173. Link: https://bit.ly/2UdTE32
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, et al. (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130: 461-470. Link: https://bit.ly/3eQIWY4
Schulman S, Kearon C (2005) Subcommittee on Control of Anticoagulation of the S, Standardization Committee of the International Society on T, Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 3: 692-694.
Hori M, Matsumoto M, Tanahashi N, Momomura S, Uchiyama S, et al. (2012) Rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation - the J-ROCKET AF study. Circ J 76: 2104-2111. Link: https://bit.ly/2z5JOsC
Poli D, Antonucci E, Testa S, Tosetto A, Ageno W, et al. (2011) Bleeding risk in very old patients on vitamin K antagonist treatment: results of a prospective collaborative study on elderly patients followed by Italian Centres for Anticoagulation. Circulation 124: 824-829. Link: https://bit.ly/371NTum
Eikelboom JW, Wallentin L, Connolly SJ, Ezekowitz M, Healey JS, et al. (2011) Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation 123: 2363-2372. Link: https://bit.ly/2XBxvhh
Halperin JL, Hankey GJ, Wojdyla DM, Piccini JP, Lokhnygina Y, et al. (2014) Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 130: 138-146. Link: https://bit.ly/2Mv1IrJ