Safety of Direct Oral Anticoagulants and Vitamin K Antagonists in Oldest Old Patients: A Prospective Study

被引：18

作者：

Rodriguez-Pascual, Carlos ^{[1
,2
,3
]}

Torres-Torres, Ivett ^{[1
]}

Gomez-Quintanilla, Alejandro ^{[1
]}

Isabel Ferrero-Martinez, Ana ^{[1
]}

Sharma, Jagdish ^{[2
,3
]}

Guitian, Alba ^{[4
]}

Carmen Basalo, Maria ^{[4
]}

Montero-Magan, Marina ^{[1
]}

Vilches-Moraga, Arturo ^{[1
,5
]}

Olcoz-Chiva, Maria-Teresa ^{[1
,2
,3
]}

Paredes-Galan, Emilio ^{[4
]}

Rodriguez-Artalejo, Fernando ^{[6
,7
]}

机构：

[1] Complejo Hosp Univ Vigo, Dept Geriatr Med, Vigo, Spain

[2] Univ Lincoln, Lincoln, Lincs, England

[3] Lincoln Cty Hosp, Lincoln, Lincs, England

[4] Complejo Hosp Univ Vigo, Dept Cardiol, Vigo, Spain

[5] Salford Royal NHS Fdn Trust, Ageing & Complex Med Dept, Manchester, Lancs, England

[6] Univ Autonoma Madrid, Dept Prevent Med & Publ Hlth, IdiPaz, CIBERESP, Madrid, Spain

[7] IMDEA Food Inst, Madrid, Spain

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2018年 / 19卷 / 11期

关键词：

Atrial fibrillation; elderly; anticoagulants; safety; NONVALVULAR ATRIAL-FIBRILLATION; NET CLINICAL BENEFIT; EURO HEART SURVEY; ELDERLY-PATIENTS; STROKE PREVENTION; ANTITHROMBOTIC THERAPY; RANDOMIZED-TRIALS; PREDICTING STROKE; RISK-FACTORS; WARFARIN;

D O I：

10.1016/j.jamda.2018.04.017

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Objective: The safety of direct oral anticoagulants (DOACs) in oldest old patients with nonvalvular atrial fibrillation (NVAF) in daily clinical practice has not been systematically assessed. This study examined the safety of DOACs and dicumarol (a vitamin K antagonist) in NVAF geriatric patients. Design: Prospective study from January 2010 through June 2015, with follow-up through January 2016. Setting: Geriatric medicine department at a tertiary hospital. Participants: A total of 554 outpatients, 75 years or older, diagnosed of NVAF and starting oral anticoagulation. Measurements: The main outcome was bleeding, which was classified into major (including those life-threatening) and nonmajor episodes. Statistical analyses were performed with Cox regression. Results: A total of 351 patients received DOACs and 193 dicumarol. Patients on DOACs were older, with more frequent comorbidities, mobility limitation and disability in activities of daily living, as well as higher mortality, than those treated with dicumarol. The incidence of any bleeding was 19.2/100 personyears among patients on DOACs and 13.7/100 person-years on dicumarol; corresponding figures for major bleeding were 5.2 for those on DOACs, and 3.3 for those on dicumarol. In crude analyses, hazard ratios (95% confidence intervals) for any bleeding, and for mayor bleeding in patients on DOACs vs dicumarol were 1.60 (1.04-2.44) and 2.22 (0.88-5.59), respectively. Excess risk of bleeding associated with DOACs vs dicumarol disappeared after adjustment for clinical characteristics, so that corresponding figures were 1.19 (0.68-2.08) and 1.01 (0.35-2.93). Results did not vary across subgroups of high-risk patients. Conclusion: In very old patients with NVAF, the higher risk of bleeding associated with DOACs vs dicumarol could be mostly explained by the worse clinical profile of patients receiving DOACs. Risk of bleeding was rather high, and warrants close clinical monitoring. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

引用

页码：936 / 941

页数：6

共 44 条

[41] BLEEDING COMPLICATIONS IN ORAL ANTICOAGULANT-THERAPY - AN ANALYSIS OF RISK-FACTORS [J].