Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis

• Published in: Journal of clinical medicine Vol. 10; no. 22; p. 5268
• Main Authors: Bonanad, Clara, García-Blas, Sergio, Torres Llergo, Javier, Fernández-Olmo, Rosa, Díez-Villanueva, Pablo, Ariza-Solé, Albert, Martínez-Sellés, Manuel, Raposeiras, Sergio, Ayesta, Ana, Bertomeu-González, Vicente, Tarazona Santabalbina, Francisco, Facila, Lorenzo, Vivas, David, Gabaldón-Pérez, Ana, Bodi, Vicente, Nuñez, Julio, Cordero, Alberto
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 12.11.2021; MDPI
• Subjects: acute coronary syndrome; Age; Anticoagulants; Cardiac arrhythmia; Clinical trials; Confidence intervals; Diabetes; direct oral anticoagulants; elderly; Hypertension; Medical prognosis; Meta-analysis; Mortality; myocardial infarction; Older people; Review; Stroke; vitamin-K antagonist; Italy; France; United States > US; Spain; vitamin-K antagonist; direct oral anticoagulants; acute coronary syndrome; elderly; myocardial infarction
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10225268

Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63-0.82; < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70-0.96; = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69-1.04; = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76-1.53; = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36-0.60; < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF.