Key result
NOAC use in atrial fibrillation patients aged 85 and older significantly reduced the risk of stroke or systemic embolism compared to non-use (HR 0.60) and aspirin use (HR 0.71).
Why the study?
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce stroke or systemic embolism in atrial fibrillation patients aged 85 and older compared to aspirin or non-use?
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce stroke or systemic embolism in atrial fibrillation patients aged 85 and older compared to aspirin or non-use?
Hazard Ratio: 0.6 (95% CI 0.53–0.69)
p-value: p=<0.001
NOACs provide a net clinical benefit in preventing thromboembolic events without significantly increasing the risk of bleeding-related death in very elderly patients with atrial fibrillation.
Atrial fibrillation (AF) has a greater prevalence and incidence with age, significantly increasing the risk of stroke, thromboembolism and dementia.Increasing evidence points towards the role of non-vitamin K antagonist oral anticoagulants (NOACs) as thromboprophylaxis, offering enhanced efficacy and safety in comparison to vitamin K antagonists.1) Nevertheless, concerns have remained about the risk of bleeding when used in very elderly patients and limited clinical trial and real-world data are available for this age group.This is compounded by elderly patients being commonly associated with multimorbidity, frailty and polypharmacy, with implications for anticoagulation options.[2][3][4] Hence, balancing thromboembolism prevention and the risk of bleeding is paramount.In this issue of the journal, the study by Choi et al. 5) provides a critical evaluation of the efficacy and safety of NOACs compared to aspirin or non-use in this vulnerable population using the data from the Korean National Healthcare Insurance registry.5) A total of 10,625 AF patients aged 85 and older without a history of intracranial hemorrhage, gastrointestinal bleeding, or prior prescription of aspirin, warfarin, or NOACs were analysed between 2015 and 2020.NOAC use in these elderly patients demonstrated significantly reduced risk of stroke or systemic embolism in comparison with aspirin use (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.60-0.85;p<0.001) and non-use (HR, 0.60; 95% CI, 0.53-0.69;p<0.001).Despite a higher incidence of bleeding in the NOAC group (HR, 1.25; 95% CI, 1.07-1.56;p=0.006), there was no corresponding increase in mortality (HR, 0.60; 95% CI, 0.45-0.81;p<0.001).Hence, NOACs provide a net clinical benefit in preventing thromboembolic events without significantly increasing the risk of bleeding-related death.This study by Choi et al. 5) provides evidence supporting the continuation of anticoagulation in very elderly AF patients.With advancing age, the delicate balance between preventing thromboembolic events and minimizing avoidable bleeding risks becomes even more
No takes yet. Share an insight, caveat, or question.
Shin et al. (2024) conducted an editorial in Atrial fibrillation (n=10,625). NOACs vs. Non-use or aspirin was evaluated on Stroke or systemic embolism (HR 0.60, 95% CI 0.53-0.69, p=<0.001). NOAC use in atrial fibrillation patients aged 85 and older significantly reduced the risk of stroke or systemic embolism compared to non-use (HR 0.60) and aspirin use (HR 0.71).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: