Key result
DOAC use in patients aged ≥80 years with non-valvular atrial fibrillation was associated with a lower risk of all-cause mortality compared to warfarin (HR 0.68; 95% CI 0.54-0.87; P=0.002).
Why the study?
The association of DOAC use with mortality in very old patients with non-valvular atrial fibrillation remained unclear, despite established efficacy and safety regarding thromboembolisms and bleeding.
Do direct oral anticoagulants reduce mortality, thromboembolisms, and major bleeding in patients aged ≥80 years with non-valvular atrial fibrillation compared to warfarin?
Cohort (n=1,208)
No
Do direct oral anticoagulants reduce mortality, thromboembolisms, and major bleeding in patients aged ≥80 years with non-valvular atrial fibrillation compared to warfarin?
Hazard Ratio: 0.68 (95% CI 0.54–0.87)
p-value: p=0.002
In very old patients (≥80 years) with non-valvular atrial fibrillation, DOAC use is associated with significantly lower mortality, thromboembolic, and bleeding risks compared to warfarin.
Supports DOAC preference over warfarin in very old NVAF patients; leaves open need for RCTs to confirm causality.
BACKGROUND: the efficacy and safety of direct oral anticoagulants (DOACs) compared with that of warfarin in very old patients with non-valvular atrial fibrillation (NVAF) have been reported in terms of thromboembolisms and bleeding. However, the association of DOAC use and mortality in such patients remains unclear. OBJECTIVES: this study aimed to investigate the incidence of mortality, as well as thromboembolisms and major bleeding, in very old patients with NVAF using DOACs as compared with warfarin. METHODS: we conducted a single-centre historical cohort study of consecutive patients with NVAF aged ≥80 years who used oral anticoagulants. We compared the 5-year outcomes (all-cause mortality, thromboembolism, major bleeding and intracranial haemorrhage) between the DOAC and Warfarin groups. RESULTS: of 1,676 patients with atrial fibrillation aged 80 years and over, 1,208 with NVAF were included. Propensity score matching provided 461 patients in each group, and the risk of all-cause mortality, thromboembolisms, major bleeding and intracranial haemorrhages was significantly lower in the DOAC group than Warfarin group (hazard ratio [95% confidence interval] for DOAC use, 0.68 [0.54-0.87], 0.31 [0.19-0.53], 0.56 [0.36-0.88], 0.23 [0.10-0.56], log-rank P = 0.002, P < 0.001, P = 0.010, P < 0.001). The mortality rate within 1 year after major bleeding was significantly lower in the DOAC group than Warfarin group (14% versus 38%, P = 0.03), however, that after a thromboembolism was similar between the two groups (33% versus 35%). CONCLUSION: patients with NVAF aged ≥80 years and using DOACs had a lower mortality than those using warfarin.
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Takahashi et al. (2022) conducted a cohort in Non-valvular atrial fibrillation (n=1,208). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on All-cause mortality (HR 0.68, 95% CI 0.54-0.87, p=0.002). DOAC use in patients aged ≥80 years with non-valvular atrial fibrillation was associated with a lower risk of all-cause mortality compared to warfarin (HR 0.68; 95% CI 0.54-0.87; P=0.002).
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