Direct Oral Anticoagulants in the Very Elderly

Eikelboom, John W.; Weitz, Jeffrey I.

doi:10.1055/a-2021-8910

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…7 A shared-decision making approach is encouraged between physicians and patients to individualize and optimize OAC therapy strategies (including dosage regimen) based on their comorbidities, comedications, values, and preferences. 7,30,31,37 This study had several strengths. The CPRD, shown to be representative of the general UK population, allowed us to assemble a large, well-defined study population of 47 242 very elderly patients with incident NVAF.…”

Section: Discussionmentioning

confidence: 99%

“…30 Therefore, which DOAC should be preferentially prescribed to these patients is uncertain. 30,31 Two cohort studies compared the effectiveness and safety of apixaban, rivaroxaban, and dabigatran in patients with NVAF older than 80. 17,18 In line with previous findings from observational studies in younger populations, one of these studies suggested that apixaban was at least as effective as dabigatran and rivaroxaban and was associated with a lower major bleeding risk in patients with NVAF over 80.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness and Safety of Edoxaban Compared With Apixaban in Elderly Patients With Nonvalvular Atrial Fibrillation: A Real-World Population-Based Cohort Study

Chiv,

Beradid,

Suissa

et al. 2024

Stroke

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BACKGROUND: The very elderly (≥80 years) are at high risk of nonvalvular atrial fibrillation and thromboembolism. Given its recent approval, the comparative effectiveness and safety of edoxaban in this population, relative to the commonly used apixaban, remain unknown. METHODS: Using the United Kingdom Clinical Practice Research Datalink, we identified a cohort of patients aged ≥80 with incident nonvalvular atrial fibrillation and newly treated with edoxaban or apixaban between 2015 and 2021. Cohort entry was defined as the first prescription for one of the 2 drugs. We used propensity score fine stratification and weighting for confounding adjustment. A weighted Cox proportional hazards model was used to estimate the hazard ratios (HR) with 95% CI of ischemic stroke/transient ischemic attack/systemic embolism (primary effectiveness outcome) and of major bleeding (primary safety outcome) associated with edoxaban compared with apixaban. We also assessed the risk of all-cause mortality and a composite outcome of ischemic stroke/transient ischemic attack, systemic embolism, gastrointestinal bleeding, and intracranial hemorrhage as secondary outcomes. RESULTS: The cohort included 7251 new-users of edoxaban and 39 991 of apixaban. Edoxaban and apixaban had similar incidence rates of thromboembolism (adjusted rates, 20.38 versus 19.22 per 1000 person-years; adjusted HR, 1.06 [95% CI, 0.89–1.26]), although the rates of major bleeding were higher with edoxaban (adjusted rates, 45.57 versus 31.21 per 1000 person-years; adjusted HR, 1.42 [95% CI, 1.26–1.61]). The risk of the composite outcome was 21% higher with edoxaban (adjusted HR, 1.21 [95% CI, 1.07–1.38]). All-cause mortality was similar between edoxaban and apixaban (adjusted HR, 1.04 [95% CI, 0.96–1.12]). CONCLUSIONS: In very elderly patients with nonvalvular atrial fibrillation, edoxaban resulted in similar thromboembolism prevention as apixaban, although it was associated with a higher risk of major bleeding. These findings may improve the management of nonvalvular atrial fibrillation by informing physicians on the choice of anticoagulant for this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Edoxaban Compared With Apixaban in Elderly Patients With Nonvalvular Atrial Fibrillation: A Real-World Population-Based Cohort Study

Chiv,

Beradid,

Suissa

et al. 2024

Stroke

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“… 125 Importantly, when using a DOAC in elderly patients with AF, adequate dosing as per the drug label should be chosen to avoid unnecessary complications. 126 …”

Section: Special Situationsmentioning

confidence: 99%

Atrial fibrillation: stroke prevention

Chao,

Potpara,

Lip

2024

The Lancet Regional Health - Europe

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“…Tailored dosing strategy including information about genotype and the concomitant use of interacting drug(s), may reduce variability in drug levels, thereby improving clinical outcomes. 3 The issue of polypharmacy, typically defined as the concomitant use of five or more medications, is indeed particularly relevant in elderly patients with AF, often associated with multiple health conditions, falls, frailty, and dementia. The study from Grymonprez et al 4 confirmed worse outcomes including increased bleeding and mortality risks associated with polypharmacy.…”

Section: Working Against the Clot Anticoagulation Managementmentioning

confidence: 99%

“…Tailored dosing strategy including information about genotype and the concomitant use of interacting drug(s), may reduce variability in drug levels, thereby improving clinical outcomes. 3…”

Section: Working Against the Clotmentioning

confidence: 99%

Thrombosis and Haemostasis 2023 Editors' Choice Papers

Weber,

Rigby,

Lip

2024

Thromb Haemost

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Direct Oral Anticoagulants in the Very Elderly

Abstract: No Abstract

Cited by 5 publications

References 19 publications

Effectiveness and Safety of Edoxaban Compared With Apixaban in Elderly Patients With Nonvalvular Atrial Fibrillation: A Real-World Population-Based Cohort Study

Effectiveness and Safety of Edoxaban Compared With Apixaban in Elderly Patients With Nonvalvular Atrial Fibrillation: A Real-World Population-Based Cohort Study

Atrial fibrillation: stroke prevention

Thrombosis and Haemostasis 2023 Editors' Choice Papers

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