Oral anticoagulation for elderly patients with non-valvular atrial fibrillation: recent insights from randomised trials and the ‘real world’

• Published in: Heart (British Cardiac Society) Vol. 103; no. 13; pp. 977 - 978
• Main Authors: Voukalis, Christos, Lip, Gregory Y H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.07.2017
• Subjects: Anticoagulants; Cardiac arrhythmia; Mortality; Stroke; Atrial fibrillation
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2017-311162

The first randomised control trial (RCT) for a currently licensed non-vitamin K antagonist oral anticoagulant (NOAC), the RE-LY trial comparing the oral direct throkbin inhibitor dabigatran with warfarin, was published. 1 This trial led to the global approval of dabigatran as an alternative to vitamin K antagonists (VKAs; eg, warfarin) for the prevention of stroke and thromboembolic events in patients with NVAF. Since the RE-LY trial, three more NOACs (ie, rivaroxaban, apixaban and edoxaban) supported by their respective RCTs against VKAs, have gained approval and the NOACs are now recommended by international guidelines as the treatment of choice for stroke prevention in NVAF. Due to the availability of additional treatment options and the minor but significant differences in some outcomes between the NOACs, guidelines recommend a more individualised patient approach regarding the selection and dosing of the available drugs. 2 In this issue, Lauw et al 3 report a substudy of the RE-LY trial investigating the influence of age on the efficacy and safety outcomes of the original RCTs for the two different doses of dabigatran, that is, 150mg twice daily and 110mg twice daily. The substudy by Lauw et al investigates the effects of two doses of dabigatran that were compared against warfarin, in different age subgroups (<75, 75 to <80, 80 to <85, >=85 years) separately, with the endpoints of mortality, stroke or systemic embolism, major bleeding, intracranial bleeding and extracranial major bleeding as related with the age and the anticoagulant with the Subpopulation Treatment Effect Pattern Plot...