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Published on: February 28, 2012
Comparison of Low-Dose Direct Oral Anticoagulants for Patients <80 Versus ≥80 Years of Age With Atrial Fibrillation
Shun Sasaki1, Yohei Sotomi2, Akio Hirata1
1Department of Cardiology, Osaka Police Hospital, Osaka, Japan.
Abstract:
Evidence on the efficacy and safety of low-dose direct oral anticoagulant (DOAC) in older patients with nonvalvular atrial fibrillation is still scarce. We conducted a single-center prospective registry of patients with nonvalvular atrial fibrillation treated with DOACs: the DIRECT registry (n = 2,216; follow-up, 407 ± 388 days, UMIN000033283). The whole population was divided into 2 groups: the older group (age ≥80 years, n = 548) versus the younger group (age <80 years, n = 1,668). Primary safety and efficacy end points were major bleeding according to the International Society on Thrombosis and Haemostasis criteria, and stroke or systemic embolism (SSE), respectively. Effects of known risk factors and low-dose DOAC on major bleeding and SSE were assessed using a multivariable Cox proportional hazards model. In the older group, low-dose DOAC was associated with lower bleeding events (hazard ratio 0.279, 95% confidence interval 0.087 to 0.892, p = 0.031) but was not associated with increased SSE (p = 0.894). In the younger group, low-dose DOAC was neither associated with risk of major bleeding nor SSE (both p >0.05). In conclusion, in older patients, low-dose DOAC was associated with reduced risk of major bleeding without compromising its efficacy.
Insights
Low-dose direct oral anticoagulants (DOACs) show reduced major bleeding in older atrial fibrillation patients. This study found no increased stroke risk, suggesting safety and efficacy in this population.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Direct oral anticoagulants (DOACs) are widely used for nonvalvular atrial fibrillation (NVAF).
- Limited data exists on the safety and efficacy of low-dose DOACs in elderly patients (≥80 years).
Purpose of the Study:
- To evaluate the safety and efficacy of low-dose DOACs in older patients with NVAF.
- To compare outcomes between older (≥80 years) and younger (<80 years) NVAF patients treated with DOACs.
Main Methods:
- Prospective, single-center registry (DIRECT registry) of 2,216 NVAF patients treated with DOACs.
- Patients divided into older (n=548) and younger (n=1,668) groups.
- Primary endpoints: major bleeding and stroke or systemic embolism (SSE); analyzed using multivariable Cox proportional hazards model.
Main Results:
- In older patients, low-dose DOAC was linked to significantly lower major bleeding events (HR 0.279, p=0.031).
- Low-dose DOAC use in older patients did not increase SSE risk (p=0.894).
- In younger patients, low-dose DOAC was not associated with increased bleeding or SSE risk (p>0.05).
Conclusions:
- Low-dose DOACs are associated with reduced major bleeding risk in elderly NVAF patients.
- The efficacy of low-dose DOACs is maintained in older NVAF patients, with no increased risk of stroke or systemic embolism.
- Findings support the use of low-dose DOACs in older NVAF patients, balancing safety and efficacy.
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