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Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study

INTRODUCTION: Direct oral anticoagulants (DOACs) are underused in the elderly, regardless the evidence in their favour in this population. METHODS: We prospectively enrolled anticoagulant-naïve patients aged ≥ 75 years who started treatment with DOACs for atrial fibrillation (AF) and stratified them...

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Autores principales: Catalani, Filippo, Campello, Elena, Occhipinti, Giuseppina, Zorzi, Alessandro, Sartori, Marta, Zanforlini, Bruno Micael, Franchin, Alessandro, Simioni, Paolo, Sergi, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543520/
https://www.ncbi.nlm.nih.gov/pubmed/37470890
http://dx.doi.org/10.1007/s11739-023-03375-9
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author Catalani, Filippo
Campello, Elena
Occhipinti, Giuseppina
Zorzi, Alessandro
Sartori, Marta
Zanforlini, Bruno Micael
Franchin, Alessandro
Simioni, Paolo
Sergi, Giuseppe
author_facet Catalani, Filippo
Campello, Elena
Occhipinti, Giuseppina
Zorzi, Alessandro
Sartori, Marta
Zanforlini, Bruno Micael
Franchin, Alessandro
Simioni, Paolo
Sergi, Giuseppe
author_sort Catalani, Filippo
collection PubMed
description INTRODUCTION: Direct oral anticoagulants (DOACs) are underused in the elderly, regardless the evidence in their favour in this population. METHODS: We prospectively enrolled anticoagulant-naïve patients aged ≥ 75 years who started treatment with DOACs for atrial fibrillation (AF) and stratified them in older adults (aged 75–84 years) and extremely older adults (≥ 85 years). Thrombotic and hemorrhagic events were evaluated for 12 months follow-up. RESULTS: We enrolled 518 consecutive patients. They were mostly aged 75–84 years (299 patients; 57.7%) vs. ≥ 85 years (219 patients; 42.3%). Extremely older adults showed higher incidence of all the endpoints (systemic cardioembolism [HR 3.25 (95% CI 1.71–6.18)], major bleeding [HR 2.75 (95% CI 1.77–4.27)], and clinically relevant non-major bleeding [HR 2.13 (95% CI 1.17–3.92)]) vs. older adults during the first year after starting anticoagulation. In patients aged ≥ 85 years, no difference in the aforementioned endpoints was found between those receiving on-label vs. off-label DOACs. In the extremely older adults, chronic kidney disease, polypharmacy, use of antipsychotics, and DOAC discontinuation correlated with higher rates of thrombotic events, whereas a history of bleeding, Charlson Index ≥ 6, use of reduced DOAC dose, absence of a caregiver, use of non-steroidal anti-inflammatory drugs (NSAIDs), and HAS-BLED score ≥ 3 were associated with major bleedings. CONCLUSIONS: Naïve patients aged ≥ 85 who started a DOAC for AF are at higher risk of thrombotic and bleeding events compared to those aged 75–84 years in the first year of therapy. History of bleeding, HAS-BLED score ≥ 3 and use of NSAIDs are associated with higher rates of major bleeding.
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spelling pubmed-105435202023-10-03 Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study Catalani, Filippo Campello, Elena Occhipinti, Giuseppina Zorzi, Alessandro Sartori, Marta Zanforlini, Bruno Micael Franchin, Alessandro Simioni, Paolo Sergi, Giuseppe Intern Emerg Med Im - Original INTRODUCTION: Direct oral anticoagulants (DOACs) are underused in the elderly, regardless the evidence in their favour in this population. METHODS: We prospectively enrolled anticoagulant-naïve patients aged ≥ 75 years who started treatment with DOACs for atrial fibrillation (AF) and stratified them in older adults (aged 75–84 years) and extremely older adults (≥ 85 years). Thrombotic and hemorrhagic events were evaluated for 12 months follow-up. RESULTS: We enrolled 518 consecutive patients. They were mostly aged 75–84 years (299 patients; 57.7%) vs. ≥ 85 years (219 patients; 42.3%). Extremely older adults showed higher incidence of all the endpoints (systemic cardioembolism [HR 3.25 (95% CI 1.71–6.18)], major bleeding [HR 2.75 (95% CI 1.77–4.27)], and clinically relevant non-major bleeding [HR 2.13 (95% CI 1.17–3.92)]) vs. older adults during the first year after starting anticoagulation. In patients aged ≥ 85 years, no difference in the aforementioned endpoints was found between those receiving on-label vs. off-label DOACs. In the extremely older adults, chronic kidney disease, polypharmacy, use of antipsychotics, and DOAC discontinuation correlated with higher rates of thrombotic events, whereas a history of bleeding, Charlson Index ≥ 6, use of reduced DOAC dose, absence of a caregiver, use of non-steroidal anti-inflammatory drugs (NSAIDs), and HAS-BLED score ≥ 3 were associated with major bleedings. CONCLUSIONS: Naïve patients aged ≥ 85 who started a DOAC for AF are at higher risk of thrombotic and bleeding events compared to those aged 75–84 years in the first year of therapy. History of bleeding, HAS-BLED score ≥ 3 and use of NSAIDs are associated with higher rates of major bleeding. Springer International Publishing 2023-07-20 2023 /pmc/articles/PMC10543520/ /pubmed/37470890 http://dx.doi.org/10.1007/s11739-023-03375-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Im - Original
Catalani, Filippo
Campello, Elena
Occhipinti, Giuseppina
Zorzi, Alessandro
Sartori, Marta
Zanforlini, Bruno Micael
Franchin, Alessandro
Simioni, Paolo
Sergi, Giuseppe
Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study
title Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study
title_full Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study
title_fullStr Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study
title_full_unstemmed Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study
title_short Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study
title_sort efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study
topic Im - Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543520/
https://www.ncbi.nlm.nih.gov/pubmed/37470890
http://dx.doi.org/10.1007/s11739-023-03375-9
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