Key result
Factor Xa inhibitors linked to ~57% fewer cardiovascular events vs non-Xa inhibitors in NVAF patients ≥80.
Why the study?
Experimental studies suggested Factor Xa inhibitors may have cardioprotective effects via protease-activated receptor 2 inhibition, but their clinical impact on cardiovascular disease was unknown.
Do Factor Xa inhibitors reduce the composite outcome of congestive heart failure, arteriosclerotic disease, and cardiovascular death in patients aged ≥80 years with nonvalvular atrial fibrillation compared to non-Factor Xa inhibitors?
Cohort (n=1,092)
No
Do Factor Xa inhibitors reduce the composite outcome of congestive heart failure, arteriosclerotic disease, and cardiovascular death in patients aged ≥80 years with nonvalvular atrial fibrillation compared to non-Factor Xa inhibitors?
Effect estimate: HR 0.43 (95% CI 0.30-0.61)
In patients aged ≥80 years with nonvalvular atrial fibrillation, Factor Xa inhibitors were associated with a significantly lower 5-year risk of cardiovascular events compared to non-Factor Xa inhibitors (dabigatran or warfarin).
Xa inhibitors were associated with lower CV risk in elderly NVAF; leaves open confirmation by randomized trials.
BACKGROUND: Experimental studies have reported that Factor Xa inhibitors (Xa-Is) have positive effects on cardiac muscles and blood vessels via protease-activated receptor 2 inhibition, suggesting the preventive effects of Xa-Is on cardiovascular events. However, the clinical impact of Xa-Is on cardiovascular disease is unknown. OBJECTIVES: This study aimed to investigate the incidence of cardiovascular events among older patients with nonvalvular atrial fibrillation (NVAF) taking Xa-Is compared with those taking non-Xa-Is. METHODS: We conducted a single-center historical cohort study of consecutive patients with NVAF who were aged ≥80 years and used oral anticoagulants. Xa-Is included rivaroxaban, apixaban, and edoxaban, and non-Xa-Is included dabigatran and warfarin. The outcome of cardiovascular events was defined as a composite outcome of congestive heart failure, arteriosclerotic disease, and cardiovascular death. We compared the 5-year incidence of cardiovascular events between patients taking Xa-Is and those taking non-Xa-Is. RESULTS: Of 1705 patients aged ≥80 years who were diagnosed with AF, 1092 patients with NVAF were enrolled. Propensity score matching provided 445 patients in each group. The risks of cardiovascular events, congestive heart failure, arteriosclerotic disease, and cardiovascular death were significantly lower in the Xa-I group than in the non-Xa-I group (hazard ratio [95% confidence interval]: 0.43 [0.30-0.61], 0.44 [0.29-0.66], 0.47 [0.22-1.04], and 0.41 [0.23-0.75], respectively). CONCLUSIONS: Among patients with NVAF who were aged ≥80 years, the incidence of cardiovascular events was lower in the Xa-I users than in the non-Xa-I users.
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Takahashi et al. (2025) conducted a cohort in nonvalvular atrial fibrillation (NVAF) (n=1,092). Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) vs. Non-Factor Xa inhibitors (dabigatran, warfarin) was evaluated on Composite outcome of congestive heart failure, arteriosclerotic disease, and cardiovascular death (HR 0.43, 95% CI 0.30-0.61). Factor Xa inhibitors significantly reduced the 5-year risk of cardiovascular events compared to non-Xa inhibitors in NVAF patients aged ≥80 years (HR 0.43; 95% CI 0.30-0.61).
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