Key result
Among patients with major bleeding on oral anticoagulants, age ≥75 years was associated with a higher rate of 1-month death compared to age <75 years (4.0% vs 1.0%; P<0.0001).
Why the study?
The study was conducted to investigate the risk of bleeding events in older patients receiving oral anticoagulants.
Do DOACs compared to warfarin reduce 1-month death and major bleeding in older patients (≥75 years) on long-term anticoagulant therapy?
Observational (n=1,919)
Do DOACs compared to warfarin reduce 1-month death and major bleeding in older patients (≥75 years) on long-term anticoagulant therapy?
In older patients on long-term anticoagulation, DOACs are associated with fewer major bleeding events compared to warfarin, with edoxaban demonstrating the lowest absolute bleeding rate among DOACs.
Answers are grounded in this paper and cite their sources.
Older patients with major bleeding on OACs face higher short-term mortality; leaves open whether specific DOACs improve outcomes versus warfarin in this group.
OBJECTIVE: To investigate the risk of bleeding events in older patients under oral anticoagulant with a 4-year survey of a catchment area with 197,722 inhabitants of whom 15,267 were on warfarin and 10,397 on direct oral anticoagulants (DOACs). METHODS: Patients presented to the Emergency Department with major bleeding were enrolled and stratified according to age ≥75 years and ongoing warfarin or DOACs. Primary endpoint was 1-month death. RESULTS: Out of 1919 major bleeding, those of patients ≥75 years of age were 1127 (59%) versus 792 (41%) <75 years of age, P < 0.0001. In patients ≥75 years of age, brain hemorrhage accounted for 612 (54%) patients, gastrointestinal hemorrhage for 301 (27%), hematuria for 104 (9%), and other hemorrhage for 108 (10%). In patients ≥75 years of age, those on warfarin accounted for 175 versus 53 on DOACs, without difference of Charlson Comorbidity Index (5.25 ± 1.92 versus 5.09 ± 1.61; P = 0.5824). One-month death in patients ≥75 of age versus <75 years of age accounted for 77 (4.0%) versus 20 (1.0%); P < 0.0001. One-month death in patients ≥75 of age on DOACs was very low, without difference versus <75 years and within DOACs. Among DOACs, absolute bleeding events showed differences as follows: 3 bleeding events for edoxaban versus 21 for dabigatran; P < 0.001; versus 16 for rivaroxaban, P = 0.006; and versus 13 for apixaban, P = 0.02. CONCLUSIONS: Major bleeding and 1-month death accounted for higher percentage in patients ≥75 years of age and in patients receiving warfarin. Among DOACs, edoxaban presented the lowest absolute rate of hemorrhage among the 4 available DOACs, without difference in mortality.
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Conti et al. (2020) conducted an observational in Major bleeding under oral anticoagulant therapy (n=1,919). Age ≥75 years vs. Age <75 years was evaluated on 1-month death (p=< 0.0001). Among patients with major bleeding on oral anticoagulants, age ≥75 years was associated with a higher rate of 1-month death compared to age <75 years (4.0% vs 1.0%; P<0.0001).
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