New Oral Anticoagulants in Elderly Adults: Evidence from a Meta‐Analysis of Randomized Trials

Objectives To evaluate the efficacy and safety of new oral anticoagulants ( NOAC s) in elderly adults. Design Meta‐analyses of randomized clinical trials ( RCT s). Setting PubMed, C ochrane L ibrary, EMBASE , W eb of S cience, and CINAHL databases were searched from J anuary 1, 2001, through M arch 30, 2013. Participants Elderly population (≥75) in RCT s comparing NOAC s (rivaroxaban, apixaban, and dabigatran) with conventional therapy. Measurements Two authors reviewed the trials, and odds ratios ( OR s) were calculated using a random effects model. Results Ten RCT s included 25,031 elderly participants. Risk of major or clinically relevant bleeding was not significantly different between NOAC s and conventional therapy in elderly adults ( OR = 1.02, 95% confidence interval = 0.73–1.43). Similar results were observed when comparing NOAC s and pharmacologically active agents. In atrial fibrillation ( AF ) trials, NOAC s were more effective than conventional therapy in prevention of stroke or systemic embolism in an elderly population with AF . In non‐ AF trials, NOAC s also had a significantly lower risk of venous thromboembolism ( VTE ) or VTE ‐related death than conventional therapy in elderly adults. Analysis for individual NOAC s showed that the NOAC was noninferior or more effective than conventional therapy for efficacy and safety outcomes. Conclusion In participants of clinical trials aged 75 and older, NOAC s did not cause excess bleeding and were associated with equal or greater efficacy than conventional therapy.