October 13, 2014Open Access
Venous thromboembolism in the elderly: efficacy and safety of non-VKA oral anticoagulants
Key Result
In a meta-analysis of elderly patients (≥75 years) with acute VTE, NOACs significantly reduced the risk of VTE recurrence compared to warfarin (RR 0.55) and were associated with a reduced risk of major bleeding.
Study Design
Type
Meta-Analysis (n=27,075)
Structured PICO
Do NOACs prevent recurrent VTE safely compared to warfarin in elderly patients and those with impaired renal function?
P
Population
Meta-analysis of 27,075 patients from four phase III trials evaluating NOACs versus warfarin for acute VTE, focusing on subgroups of elderly patients (≥75 years) and those with impaired renal function.
I
Intervention
Non-VKA oral anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban, edoxaban)
C
Comparator
Warfarin (VKAs)
O
Outcome
Recurrent venous thromboembolism (VTE)hard clinical
NOACs offer an effective, safer, and more convenient alternative to warfarin for the treatment of acute VTE in elderly patients and those with impaired renal function.
Main Result
Relative Risk: 0.55 (95% CI 0.38–0.82)
Limitations
- Individual trials were insufficiently powered for subgroup analyses.
- Combined results for elderly patients with renal dysfunction were not reported.
- Trials included very few patients over 80 or 90 years old and excluded those with severe renal insufficiency or high bleeding risk.
- Different types and durations of initial therapies were used across the included trials.
- Not all bleeding outcomes in relation to the subgroups of interest were reported (e.g., HOKUSAI trial).
Abstract
Increasing age and renal impairment are risk factors for venous thrombosis but also for anticoagulant-induced bleeding. In large-scale phase III trials, non-VKA oral anticoagulants (NOACs) were at least as effective and safe for the treatment of acute venous thromboembolism as warfarin. Here, we review the efficacy and safety of dabigatran, rivaroxaban, apixaban and edoxaban in the subgroups of elderly patients (≥75 years) and patients with impaired renal function (creatinine clearance ≤50 ml/min). In all phase III trials, the efficacy of NOACs in the prevention of recurrent VTE was conserved both in the elderly subgroup and in the subgroup with impaired renal function. In a meta-analysis of the pooled results, NOACs reduced VTE recurrence compared with warfarin in elderly patients. In elderly patients and patients with impaired renal function, the safety of NOACs was in line with the results of the overall study. NOACs may offer an effective, safer and more convenient alternative for VKAs also in the elderly. However, the efficacy/safety profile of NOACs in the aged population needs to be confirmed in real-life.