Key result
DOACs show no benefit over VKAs for all-cause mortality in elderly AF patients.
Why the study?
Selecting the optimal oral anticoagulation therapy for elderly patients with atrial fibrillation remains challenging.
Do DOACs improve all-cause mortality compared to VKAs in hospitalized atrial fibrillation patients aged ≥ 75 years?
Cohort (n=450)
Do DOACs improve all-cause mortality compared to VKAs in hospitalized atrial fibrillation patients aged ≥ 75 years?
Effect estimate: aHR 0.79 (95% CI 0.58-1.06)
In very elderly hospitalized patients with atrial fibrillation, DOACs and VKAs demonstrated similar rates of all-cause mortality and secondary clinical outcomes over 3.7 years.
No mortality difference between DOACs and VKAs in very elderly AF; leaves open need for RCTs to guide practice.
BACKGROUND: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in this demographic. METHODS: This post hoc analysis of the MISOAC-AF trial focused on hospitalized AF patients aged ≥ 75 years prescribed OAC at discharge. Predictors of VKA and reduced DOAC dosing were identified using adjusted odds ratios (aORs). Cox regression models calculated adjusted hazard ratios (aHRs) for primary (all-cause mortality) and secondary outcomes (stroke, bleeding, AF or heart failure hospitalization, cardiovascular death). RESULTS: Among 450 elderly patients, 63.6% received DOACs and 36.4% received VKAs. Higher CHA2DS2-VASc and HAS-BLED scores and antiplatelet use predicted VKA prescription. Hypertension, prior stroke, and bleeding history favored DOAC use. Advanced age and chronic kidney disease correlated with reduced DOAC dosing. Over a 3.7-year follow-up period, there was no significant difference in all-cause mortality between the DOAC and VKA groups (aHR 0.79, 95% CI 0.58-1.06) or between the full-dose and reduced-dose DOAC groups (aHR 0.96, 95% CI 0.60-1.53). Secondary analyses also did not yield statistically significant results in either comparison. CONCLUSIONS: Clinical profile parameters in elderly AF patients predict VKA or DOAC use. Clinical outcomes were similar between different OAC therapies.
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Zergioti et al. (2025) conducted a cohort in Atrial Fibrillation (n=450). Direct-acting oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on All-cause mortality (aHR 0.79, 95% CI 0.58-1.06). Direct-acting oral anticoagulants showed no significant difference in all-cause mortality compared to vitamin K antagonists in elderly AF patients (aHR 0.79; 95% CI 0.58-1.06).
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