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Abstract 15084: A Retrospective Analysis of Atrial Fibrillation Patients Aged 80 Years and Older Prescribed a Low-dose Non-vitamin K Antagonist Anticoagulant
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Abstract 15084: A Retrospective Analysis of Atrial Fibrillation Patients Aged 80 Years and Older Prescribed a Low-dose Non-vitamin K Antagonist Anticoagulant

Usman A Chaudhry, Michael Ezekowitz, Edward J Gracely, Catrina M Wolfe, Grace M Harper and Glenn Harper
Circulation (New York, N.Y.), v 142(Suppl_3), pp A15084-A15084
17 Nov 2020
DOI: https://doi.org/10.1161/circ.142.suppl_3.15084

Abstract

Background: The very elderly and those receiving low doses of the direct-acting oral anticoagulants (DOACs) were underrepresented in trials leading to the approval of Apixaban 2.5 mgs BID (A), Rivaroxaban 15mgs daily (R) and Edoxaban 30 mgs daily (E). Approval of dabigatran 75mgs BID (D) was based entirely on pharmacokinetic studies. Methods: Retrospective analysis of the electronic medical record of a multi-disciplinary practice of 396,064 patients between 1/1/11 (when first DOAC available) and 5/31/17. Results: 9,446 patients had Atrial Fibrillation (AF), with 2,660 prescribed a DOAC and 846 at the low dose with 514 ≥ 80 yrs (range 80 – 98) with a mean CHA 2 DS 2 -VASc score of 4.5, which did not differ between patients prescribed D, R or A (p = 0.66 by ANOVA). Fifty-three patients received D, first used on 2/26/11, 223 R, first used on 12/15/11, and 236 A, first used on 6/19/12, and one patient received E. Among 28 baseline variables there were no clinically relevant differences among D, R, and A. All outcomes were reported as time to first event. All-cause mortality, n = 5 (5.5%/yr) for D, n =15 (4.2%) for R, and n = 23 (9.5%) for A, p = 0.031 by log rank test (with A > R by pairwise log-rank, p = 0.013). Major bleeding n = 13 (14.3%/yr) for D, n = 50 (14.1%) for R, and n = 22 (9.1%) for A, p = 0.048 by log rank test (with A < R, p = 0.017). Intracranial bleeding n = 2 (2.2%/yr) for D, n = 6 (1.7%) for R, and n = 2 (0.8%) for A, p = 0.53. There were 7 ischemic strokes or systemic embolic events (SSE) in total (1.1%/yr): D, R, and A (p = 0.94). Comparisons involving D may be underpowered. 245 patients (47.7%) remained on their prescribed drug without an event for the observation period (p = 0.55). Conclusion: D, R and A were well tolerated in patients ≥ 80 yrs, with low SSE and intracranial bleed rates. Major bleeds were the most frequent outcome, lowest in patients prescribed A. A had a higher all-cause mortality.

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Web of Science research areas
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
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