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Elderly Bleeding Risk of Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation: A Systematic Review and

Jessika Lobraico-Fernandez1, Salma Baksh2, Eric Nemec3

  • 1Sacred Heart University Physician Assistant Studies, Fairfield, CT, USA.

Drugs in R&D
|May 26, 2019
PubMed

Insights

In elderly patients with nonvalvular atrial fibrillation, apixaban and dabigatran significantly reduce major bleeding risk compared to warfarin. Rivaroxaban showed no significant difference in bleeding risk versus warfarin.

Area of Science:

  • Cardiology
  • Pharmacology
  • Geriatrics

Background:

  • Current guidelines recommend anticoagulation for atrial fibrillation but lack specific guidance for the elderly.
  • Direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, and apixaban are alternatives to warfarin, with limited research on their bleeding risks in older adults.

Purpose of the Study:

  • To systematically review and compare the bleeding risk of different DOACs in elderly patients with nonvalvular atrial fibrillation (NVAF).

Main Methods:

  • A systematic review and meta-analysis of studies reporting major bleeding events requiring hospitalization.
  • Included patients with NVAF, excluded those with severe renal failure.
  • Hazard ratios and 95% confidence intervals were calculated using a random-effects model.

Main Results:

  • Apixaban and dabigatran demonstrated statistically significant reductions in major bleeding risk compared to warfarin (40% and 21% respectively).
  • Rivaroxaban did not show a statistically significant difference in bleeding risk compared to warfarin.
  • Data for edoxaban was insufficient for inclusion in the meta-analysis.

Conclusions:

  • Apixaban and dabigatran are associated with a significantly lower risk of major bleeding in elderly NVAF patients compared to warfarin.
  • Further head-to-head trials are needed to definitively establish the comparative bleeding risks of all DOACs.
Abstract

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