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Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation

Patti, Giuseppe; Pecen, Ladislav; Lucerna, Markus; Huber, Kurt; Rohla, Miklos; Renda, Giulia; Siller-Matula, Jolanta; Ricci, Fabrizio LU ; Kirchhof, Paulus and De Caterina, Raffaele (2019) In American Journal of Medicine 132(6). p.5-757
Abstract

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)... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, Cardiovascular events, Elderly, Major bleeding, Net clinical benefit, NOACs, VKAs
in
American Journal of Medicine
volume
132
issue
6
pages
5 - 757
publisher
Elsevier
external identifiers
  • scopus:85061445114
ISSN
0002-9343
DOI
10.1016/j.amjmed.2018.12.036
language
English
LU publication?
yes
id
c8919f35-f35b-4f50-8454-fa7371b08e98
date added to LUP
2019-02-22 10:10:14
date last changed
2019-08-18 04:55:51
@article{c8919f35-f35b-4f50-8454-fa7371b08e98,
  abstract     = {<p>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.</p>},
  author       = {Patti, Giuseppe and Pecen, Ladislav and Lucerna, Markus and Huber, Kurt and Rohla, Miklos and Renda, Giulia and Siller-Matula, Jolanta and Ricci, Fabrizio and Kirchhof, Paulus and De Caterina, Raffaele},
  issn         = {0002-9343},
  keyword      = {Atrial fibrillation,Cardiovascular events,Elderly,Major bleeding,Net clinical benefit,NOACs,VKAs},
  language     = {eng},
  month        = {01},
  number       = {6},
  pages        = {5--757},
  publisher    = {Elsevier},
  series       = {American Journal of Medicine},
  title        = {Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation},
  url          = {http://dx.doi.org/10.1016/j.amjmed.2018.12.036},
  volume       = {132},
  year         = {2019},
}