Key result
Non-vitamin K oral anticoagulants are effective and safe alternatives to warfarin in elderly patients with non-valvular atrial fibrillation, offering a net clinical benefit primarily driven by reduced intracranial hemorrhage.
Why the study?
Do NOACs compared to warfarin improve the risk-benefit ratio of thromboembolic and hemorrhagic events in elderly patients with non-valvular atrial fibrillation?
Do NOACs compared to warfarin improve the risk-benefit ratio of thromboembolic and hemorrhagic events in elderly patients with non-valvular atrial fibrillation?
While NOACs overcome many limitations of warfarin in elderly patients with non-valvular atrial fibrillation, prudent use and comprehensive geriatric assessments are necessary due to their frequent exclusion from clinical trials.
Supports cautious NOAC use in elderly AF with geriatric assessment; leaves open questions for frail subgroups excluded from trials.
Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive assessment, besides the scores addressing risk of thromboembolic and hemorrhagic events. In the meantime, it is mandatory that use of anticoagulant therapy in most elderly people, currently excluded from randomized controlled trials, is prudent and responsible.
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Vetta et al. (2017) conducted a review in Non-valvular atrial fibrillation. Non-vitamin K oral anticoagulants (NOACs) vs. Warfarin (Vitamin K antagonists) was evaluated. Non-vitamin K oral anticoagulants are effective and safe alternatives to warfarin in elderly patients with non-valvular atrial fibrillation, offering a net clinical benefit primarily driven by reduced intracranial hemorrhage.
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