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

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 endpoin...

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Published inJournal 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
LanguageEnglish
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
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Abstract 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.
AbstractList 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; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70–0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76–1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36–0.60; p < 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.
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; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70-0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69-1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76-1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36-0.60; p < 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.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; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70-0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69-1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76-1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36-0.60; p < 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.
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; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70–0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76–1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36–0.60; p < 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.
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.
Author Tarazona Santabalbina, Francisco
Facila, Lorenzo
Cordero, Alberto
Gabaldón-Pérez, Ana
Martínez-Sellés, Manuel
Díez-Villanueva, Pablo
Vivas, David
Ayesta, Ana
García-Blas, Sergio
Fernández-Olmo, Rosa
Torres Llergo, Javier
Bodi, Vicente
Ariza-Solé, Albert
Raposeiras, Sergio
Nuñez, Julio
Bertomeu-González, Vicente
Bonanad, Clara
AuthorAffiliation 4 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain; mmselles@secardiologia.es (M.M.-S.); vbertog@gmail.com (V.B.-G.)
5 Cardiology Department, Hospital Universitario de Jaén, 23007 Jaén, Spain; javiertorresllergo@gmail.com (J.T.L.); mariarosafernandezolmo@gmail.com (R.F.-O.)
6 Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; pablo_diez_villanueva@hotmail.com
12 Department of Clinical Medicine, Universidad Miguel Hernandez, 03550 Alicante, Spain
15 Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; dvivas@secardiologia.es
8 Cardiology Department, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain
11 Cardiology Department, Hospital Universitario de San Joan, 03550 Alicante, Spain
3 Department of Medicine, Medicine Faculty, 46010 Valencia, Spain
13 Geriatrics Department, Hospital Universitario de la Ribera, 46600 Alzira, Spain; fjtarazonas@gmail.com
10 Cardiology Department,
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Issue 22
Keywords vitamin-K antagonist
direct oral anticoagulants
acute coronary syndrome
elderly
myocardial infarction
Language English
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Both authors contributed equally as first authors.
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OpenAccessLink https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618042/
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PublicationCentury 2000
PublicationDate 20211112
PublicationDateYYYYMMDD 2021-11-12
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  year: 2021
  text: 20211112
  day: 12
PublicationDecade 2020
PublicationPlace Switzerland
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PublicationTitle Journal of clinical medicine
PublicationTitleAlternate J Clin Med
PublicationYear 2021
Publisher MDPI AG
MDPI
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Snippet Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with...
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StartPage 5268
SubjectTerms 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
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Title Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
URI https://www.ncbi.nlm.nih.gov/pubmed/34830548
https://www.proquest.com/docview/2602082365/abstract/
https://www.proquest.com/docview/2604019374/abstract/
https://pubmed.ncbi.nlm.nih.gov/PMC8618042
https://doaj.org/article/2fc5cdb571224da6869f5687b588da90
Volume 10
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