Key result
NOACs linked to ~23% lower stroke or systemic embolism risk vs. VKAs in frail AF.
Why the study?
Data on NOAC use in patients with atrial fibrillation and frailty are scarce.
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce stroke, mortality, and bleeding compared to vitamin K antagonists in frail patients with atrial fibrillation?
Cohort (n=254,478)
Yes
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce stroke, mortality, and bleeding compared to vitamin K antagonists in frail patients with atrial fibrillation?
NOACs demonstrate a superior benefit-risk profile compared to VKAs in frail patients with atrial fibrillation, with apixaban showing the most favorable bleeding profile.
Answers are grounded in this paper and cite their sources.
Supports NOAC preference over VKAs in frail patients with atrial fibrillation; extends observational safety.
AIMS: Data on non-vitamin K antagonist oral anticoagulants (NOACs) use in patients with atrial fibrillation (AF) and frailty are scarce. Therefore, the impact of frailty on AF-related outcomes and benefit-risk profiles of NOACs in patients with frailty were investigated. METHODS AND RESULTS: AF patients initiating anticoagulation between 2013 and 2019 were included using Belgian nationwide data. Frailty was assessed with the Claims-based Frailty Indicator. Among 254 478 anticoagulated AF patients, 71 638 (28.2%) had frailty. Frailty was associated with higher all-cause mortality risks [adjusted hazard ratio (aHR) 1.48, 95% confidence interval (CI) (1.43-1.54)], but not with thromboembolism or bleeding. Among subjects with frailty (78 080 person-years of follow-up), NOACs were associated with lower risks of stroke or systemic embolism (stroke/SE) [aHR 0.77, 95%CI (0.70-0.86)], all-cause mortality [aHR 0.88, 95%CI (0.84-0.92)], and intracranial bleeding [aHR 0.78, 95%CI (0.66-0.91)], a similar major bleeding risk [aHR 1.01, 95%CI (0.93-1.09)], and higher gastrointestinal bleeding risk [aHR 1.19, 95%CI (1.06-1.33)] compared with VKAs. Major bleeding risks were lower with apixaban [aHR 0.84, 95%CI (0.76-0.93)], similar with edoxaban [aHR 0.91, 95%CI (0.73-1.14)], and higher with dabigatran [aHR 1.16, 95%CI (1.03-1.30)] and rivaroxaban [aHR 1.11, 95%CI (1.02-1.21)] compared with VKAs. Apixaban was associated with lower major bleeding risks compared with dabigatran [aHR 0.72, 95%CI (0.65-0.80)], rivaroxaban [aHR 0.78, 95%CI (0.72-0.84)] and edoxaban [aHR 0.74, 95%CI (0.65-0.84)], but mortality risk was higher compared with dabigatran and edoxaban. CONCLUSION: Frailty was an independent risk factor of death. Non-vitamin K antagonist oral anticoagulants had better benefit-risk profiles than VKAs in patients with frailty, especially apixaban, followed by edoxaban.
No takes yet. Share an insight, caveat, or question.
Grymonprez et al. (2023) conducted a cohort in Atrial fibrillation and frailty (n=254,478). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Stroke or systemic embolism (aHR 0.77, 95% CI 0.70-0.86). Among atrial fibrillation patients with frailty, NOAC use was associated with a 23% lower risk of stroke or systemic embolism (aHR 0.77) and a lower risk of all-cause mortality compared with VKAs.
Synapse has enriched 10 related papers. Consider them for comparative context: