Clinical profile of direct oral anticoagulants versus vitamin K anticoagulants in octogenarians with atrial fibrillation: a multicentre propensity score matched real-world cohort study

Effectiveness and Safety of Oral Anticoagulants in Older Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…Mortality rates in NOAC users were similar (Nishida et al, 2019;Mitchell et al, 2019) to even significantly lower (Deitelzweig et al, 2019;Poli et al, 2019;Russo et al, 2019;Alcusky et al, 2020;Chao et al, 2020) as compared to warfarin. In terms of safety, NOACs were associated with a similar (Giustozzi et al, 2019;Mitchell et al, 2019;Nishida et al, 2019;Poli et al, 2019;Russo et al, 2019;Chao et al, 2020) to lower Shinohara et al, 2019;Nishida et al, 2019;Chao et al, 2020;Wong et al, 2020) major bleeding, a similar (Hohmann et al, 2019; to significantly higher (Mitchell et al, 2019;Wong et al, 2020) gastrointestinal bleeding and a lower (Hohmann et al, 2019;Mitchell et al, 2019;Chao et al, 2020;Wong et al, 2020) intracranial bleeding risk (except for a similar risk in one study) (Russo et al, 2019) as compared to VKAs in AF patients ≥75, ≥80, ≥85 and ≥90 years old (Shinohara et al, 2019;Hohmann et al, 2019;Nishida et al, 2019;Mitchell et al, 2019;Giustozzi et al, 2019;Russo et al, 2019;Poli et al, 2019;Chao et al, 2020). Interestingly, in AF patients ≥90 years old, the use of NOACs as compared to no anticoagulation was associated with a significantly lower risk for the composite effectiveness endpoint (stroke/SE, pulmonary embolism and death), and a borderline similar risk for major bleeding and intracranial bleeding (Raposeiras-Roubıń et al, 2020).…”

“…In terms of effectiveness, NOACs had an equal stroke/SE risk as compared to VKAs in AF patients ≥75, ≥80, ≥85, and ≥90 years old ( Avgil-Tsadok et al., 2016 ; Lai et al., 2018 ; Giustozzi et al., 2019 ; Hohmann et al., 2019 ; Nishida et al., 2019 ; Mitchell et al., 2019 ; Russo et al., 2019 ; Shinohara et al., 2019 ; Alcusky et al., 2020 ). Some studies even described a significantly lower stroke/SE ( Deitelzweig et al., 2019 ; Kim et al., 2019 ) and ischemic stroke risk ( Mitchell et al., 2019 ; Deitelzweig et al., 2019 ; Chao et al., 2020 ), as opposed to a higher stroke/transient ischemic attack (TIA) risk in one small Italian study ( Poli et al., 2019 ) and a borderline increased ischemic stroke/TIA risk for apixaban in another study due to off-label underdosing ( Alcusky et al., 2020 ).…”

“…Some studies even described a significantly lower stroke/SE (Deitelzweig et al, 2019; and ischemic stroke risk (Mitchell et al, 2019;Deitelzweig et al, 2019;Chao et al, 2020), as opposed to a higher stroke/transient ischemic attack (TIA) risk in one small Italian study (Poli et al, 2019) and a borderline increased ischemic stroke/TIA risk for apixaban in another study due to off-label underdosing (Alcusky et al, 2020). Mortality rates in NOAC users were similar (Nishida et al, 2019;Mitchell et al, 2019) to even significantly lower (Deitelzweig et al, 2019;Poli et al, 2019;Russo et al, 2019;Alcusky et al, 2020;Chao et al, 2020) as compared to warfarin. In terms of safety, NOACs were associated with a similar (Giustozzi et al, 2019;Mitchell et al, 2019;Nishida et al, 2019;Poli et al, 2019;Russo et al, 2019;Chao et al, 2020) to lower Shinohara et al, 2019;Nishida et al, 2019;Chao et al, 2020;Wong et al, 2020) major bleeding, a similar (Hohmann et al, 2019; to significantly higher (Mitchell et al, 2019;Wong et al, 2020) gastrointestinal bleeding and a lower (Hohmann et al, 2019;Mitchell et al, 2019;Chao et al, 2020;Wong et al, 2020) intracranial bleeding risk (except for a similar risk in one study) (Russo et al, 2019) as compared to VKAs in AF patients ≥75, ≥80, ≥85 and ≥90 years old (Shinohara et al, 2019;Hohmann et al, 2019;Nishida et al, 2019;Mitchell et al, 2019;…”

Non‐vitamin K vs vitamin K oral anticoagulants in patients aged > 80 year with atrial fibrillation and low body weight

“…[16][17][18][19] Older people are more likely to be underweight than young adults and are susceptible to rapid weight loss in response to illness, stress and the ageing process itself; therefore, the low body weight is a frequent comorbidity among elderly, which exposes the patients at an increased greater risk of mortality than those who are overweigh. 6,20 Based on data emerged from randomized clinical trials 8,21,22 and real-world experiences, [23][24][25] NOACs shows a better net clinical benefit vs VKAs among octogenarians with AF: in a recent study, our group compared the safety and efficacy of NOACs versus well-controlled VKA therapy among octogenarians with AF. 24 NCB is a quantitative method that compares the overall change in the drug benefits and risks over a comparator and creates a composite outcome encompassing both drug efficacy and safety in a single quantitative and intuitive measure.…”

“…6,20 Based on data emerged from randomized clinical trials 8,21,22 and real-world experiences, [23][24][25] NOACs shows a better net clinical benefit vs VKAs among octogenarians with AF: in a recent study, our group compared the safety and efficacy of NOACs versus well-controlled VKA therapy among octogenarians with AF. 24 NCB is a quantitative method that compares the overall change in the drug benefits and risks over a comparator and creates a composite outcome encompassing both drug efficacy and safety in a single quantitative and intuitive measure. 26 We used NCB to assess the balance of risk and benefit of NOACs versus VKAs in a single quantitative measure including the two more fearsome complications of anticoagulant therapy: thromboembolic events and intracranial haemorrhages.…”