Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation

Polymeris, Alexandros A, Macha, Kosmas, Paciaroni, Maurizio, Wilson, Duncan, Koga, Masatoshi, Cappellari, Manuel, Schaedelin, Sabine, Zietz, Annaelle, Peters, Nils, Seiffge, David J
et al (show 32 more authors) (2022) Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation. ANNALS OF NEUROLOGY, 91 (1). pp. 78-88.

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<h4>Objective</h4>To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years.<h4>Methods</h4>Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (<3 months) aged ≥85 versus <85 years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all-cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk.<h4>Results</h4>In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged ≥85 years and 3,688 (62%) received a DOAC. During 6,874 patient-years follow-up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged ≥85 (HR<sub>≥85y</sub>  = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR<sub><85y</sub>  = 0.79, 95%-CI [0.66, 0.95]) in simple (p<sub>interaction</sub>  = 0.129), adjusted (p<sub>interaction</sub>  = 0.094) or weighted (p<sub>interaction</sub>  = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1).<h4>Interpretation</h4>The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2022;91:78-88.

Item Type: Article
Uncontrolled Keywords: NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, RAF, RAF-DOAC, SAMURAI-NVAF and Verona Registry Collaborators, Humans, Atrial Fibrillation, Vitamin K, Aged, 80 and over, Female, Male, Stroke, Factor Xa Inhibitors
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 17 Oct 2023 14:31
Last Modified: 17 Oct 2023 14:31
DOI: 10.1002/ana.26267
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3173825