Atrial fibrillation: direct oral anticoagulants effective in elderly with multiple comorbidities

  • Mentias A & al.
  • JAMA Netw Open

  • from Sarfaroj Khan
  • Clinical Summaries
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Takeaway

  • Direct oral anticoagulants, rivaroxaban and dabigatran, were effective in elderly patients with atrial fibrillation and multiple chronic conditions (MCC), but dabigatran was associated with lower risk for major haemorrhage.

Why this matters

  • With advancing medical treatments, elderly patients live longer with increasingly complex medical conditions and coexisting comorbidities.
  • Findings support the use of direct oral anticoagulants in patients with complex illness.

Study design

  • 146,871 patients with newly diagnosed atrial fibrillation and multiple chronic conditions received rivaroxaban, dabigatran or warfarin therapy between 2010 and 2013.
  • Outcomes: Ischaemic stroke, major haemorrhage and death.
  • Funding: Agency for Healthcare Research and Quality; Health Services Research and Development Service of the Department of Veterans Affairs.

Key results

  • Mean age in patients receiving rivaroxaban, dabigatran or warfarin was 75.75, 75.83, and 78.45 years, respectively.
  • Rates of stroke were similar between the 3 drugs.
  • Dabigatran was associated with lower risk for major haemorrhage vs warfarin in patients with low MCC (HR, 0.62; P<.001 for mcc defined as low cha2ds2-vasc score and similar risk in patients with moderate to high mcc.>
  • No difference was observed in risk for major haemorrhage between rivaroxaban and warfarin.
  • Rivaroxaban had a significantly higher risk for major haemorrhage vs dabigatran in the medium (HR, 1.24; P=.02) and high comorbidity groups (HR, 1.28; P=.01).
  • Dabigatran and rivaroxaban were associated with lower risk for mortality compared with warfarin (HR range, 0.52-0.84), across comorbidity levels.
  • No difference was observed in the risk for mortality between rivaroxaban and dabigatran.

Limitations

  • Retrospective study.