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Comparison of Low-Dose Direct Acting Anticoagulant and Warfarin in patients Aged >= 80 years With Atrial Fibrillation
Journal article   Peer reviewed

Comparison of Low-Dose Direct Acting Anticoagulant and Warfarin in patients Aged >= 80 years With Atrial Fibrillation

Usman A. Chaudhry, Michael D. Ezekowitz, Edward J. Gracely, Winson T. George, Catrina M. Wolfe, Grace Harper and Glenn R. Harper
The American journal of cardiology, v 152, pp 69-77
01 Aug 2021
DOI: https://doi.org/10.1016/j.amjcard.2021.04.035
PMID: 34162485
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology
Low dose direct acting oral anticoagulants (LDDOACS) were approved for elderly atrial Fibrillation (AF) patients with limited information. A retrospective analysis collecting baseline characteristics and outcomes in AF patients >= 80 prescribed LDDOAC or warfarin (W), from a multidisciplinary practice between 1/1/11 (First LDDOAC available) and 5/31/17 was conducted. From 9660 AF patients, 514 >= 80 received a LDDOAC and 422 W. A multivariable comparison found LDDOAC patients were older (p < 0.001), had lower creatinine clearance (CrCl) (p = 0.006), used more anti-platelet drugs (p < 0.001), and more often had new onset AF verses those prescribed W (p < 0.001). There were no clinically significant differences among those patients receiving Dabigatran 75 mgs BID (D), Rivaroxaban 15mgs (R) or Apixaban 2.5mgs BID (A). Forty-eight and 50% of the patients remained on their LDDOAC or W for the observation period (p = 0.55). Stroke/systemic embolism (SSE) and CNS bleeds were 1.16 vs 2.22%/yr., (p = 0.143) and 1.46 vs 0.93%/yr., (p = 0.24). Mortality and major bleeds were 6.26 vs 1.67%/yr., and 12.3vs 3.77%/yr. (p<0.001). SSE were 1.1%/yr for D, R, and A (p = 0.94). CNS bleeds were 2.2 for D, 1.7 for R and 0.8%/yr. for A: p = 0.53. Major bleeding was: 14.3 for D, 14.1 for R and 9.1%/yr. for A, p = 0.048 (with A < R, p = 0.01). Mortality was 5.5 for D, 4.2 for R and 9.5% for A, p = 0.031. In conclusion, half the patients remained on their assigned anti-coagulant. SSE and intracranial bleed rates were similar and low. Major bleeds and deaths were different between groups emphasizing the need for prospective randomized trials in this growing population with AF. (C) 2021 Published by Elsevier Inc.

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Cardiac & Cardiovascular Systems
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