Why the study?
Although DOAC use has grown and adverse events have decreased in NVAF, no studies had demonstrated a correlation between them, and data were especially limited in very old patients.
Does the increased use of DOACs correlate with a reduced incidence of thromboembolisms and major bleeding events in patients with NVAF aged ≥80 years?
Does the increased use of DOACs correlate with a reduced incidence of thromboembolisms and major bleeding events in patients with NVAF aged ≥80 years?
The increased prescription of DOACs over a decade in very old patients with NVAF is associated with a significant decrease in thromboembolisms and major bleeding events.
Increased DOAC use was associated with fewer events in very old NVAF patients; leaves open whether DOACs drove the trend or other factors contributed.
Aims Direct oral anticoagulants (DOACs) have become the first-line antithrombotic therapy in patients with non-valvular atrial fibrillation (NVAF). During this period, the incidence of thromboembolisms and major bleeding events has decreased. However, no studies have shown a correlation between them, and even fewer data are available on older patients. Therefore, we evaluated the serial changes in oral anticoagulant (OAC) use and the correlation between DOAC use and the incidence of adverse events among very old patients with NVAF. Methods and results We conducted a historical cohort study in 1320 consecutive patients with NVAF aged ≥80 years who received medical treatment for AF from March 2011 to February 2021. We analysed the temporal trends regarding patients using OACs, including the DOAC prescription rate and incidence of adverse events. Over the last decade, the number of patients using OACs has increased from 228 to approximately 600 person-years. The DOAC prescription rate has significantly increased (4–90%, P < 0.001). The age of the patients and proportion of patients with a HASBLED score ≥3 significantly increased (84 ± 4 to 86 ± 4 years, 16–25%, P < 0.001, respectively). The composite incidence of thromboembolisms and major bleeding events significantly decreased (7.02–3.30 events/100 person-years, P < 0.001). Conclusion The incidence of thromboembolisms and major bleeding events might be inversely correlated with the increase in the DOAC prescription rate in patients with NVAF aged ≥80 years.
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Takahashi et al. (2023) studied this question.
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