Key result
DOACs provide safer stroke prevention than warfarin in elderly AF, driven by less intracranial hemorrhage.
Why the study?
Do direct oral anticoagulants prevent stroke safely compared to warfarin in elderly patients (aged ≥75 years) with atrial fibrillation?
Do direct oral anticoagulants prevent stroke safely compared to warfarin in elderly patients (aged ≥75 years) with atrial fibrillation?
DOACs are an effective and safer alternative to warfarin in elderly patients with atrial fibrillation, helping to overcome historical underutilization driven by the fear of intracranial bleeding.
Supports preferential DOAC use in elderly AF to address under-treatment; leaves open frailty-specific dosing trials.
Elderly patients with atrial fibrillation are at a higher risk of both ischemic and bleeding events compared with younger patients; therefore, balancing risks and benefits of antithrombotic strategies in this population is crucial. Recent studies have shown that because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation is the highest in elderly patients in whom it outweighs the risk of bleeding. Direct oral anticoagulants (DOACs) have been developed as a treatment for the prevention of cardioembolic stroke to overcome some limitations of warfarin, such as the need for frequent monitoring, labile INR values requiring frequent dose adjustment, dietary and drugs interactions, and increased risk of intracranial bleeding. Despite the better safety profiles of DOACs compared with warfarin, elderly patients often remain undertreated because of the fear of bleeding complications. This review summarizes current evidence regarding the risks of thromboembolisms and bleeding in different antithrombotic strategies in elderly patients (aged ≥75 years) with atrial fibrillation, including data from the warfarin-controlled phase 3 DOACs trials.
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Ilaria Cavallari (2018) conducted a review in Atrial fibrillation. Direct oral anticoagulants vs. Warfarin or antiplatelet agents was evaluated on Efficacy (prevention of cardioembolic stroke) and safety (major and intracranial bleeding). Direct oral anticoagulants offer an effective and safer alternative to warfarin for stroke prevention in elderly patients with atrial fibrillation, primarily driven by consistently lower rates of intracranial hemorrhage.
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