Direct oral anticoagulants were associated with a slightly lower risk of ischaemic stroke, a 44% lower risk of intracranial haemorrhage, and a 46% higher risk of GI bleeding compared to VKAs.
Meta-Analysis
Do direct oral anticoagulants (DOACs) reduce ischaemic stroke and improve safety compared to Vitamin K Antagonists in people aged ≥75 years with atrial fibrillation?
DOACs may be preferable for most older patients (≥75 years) with atrial fibrillation due to lower intracranial hemorrhage risk, provided they are not at high risk for gastrointestinal bleeding.
Older people, are underrepresented in randomised controlled trials of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation (AF). The aim of this study was to combine data from observational studies to provide evidence for the treatment of people aged ≥75 years. Medline, Embase, Scopus and Web of Science were searched. The primary effectiveness outcome was ischaemic stroke. Safety outcomes were major bleeding, intracranial haemorrhage, gastrointestinal bleeding, myocardial infarction, and mortality. Twenty-two studies were eligible for inclusion. Two studies related specifically to people ≥75 years but were excluded from meta-analysis due to low quality; all data in the meta-analyses were from subgroups. The pooled risk estimate of ischaemic stroke was slightly lower for DOACs. There was no significant difference in major bleeding, mortality, or myocardial infarction. Risk of intracranial haemorrhage was 44% lower with DOACs, but risk of GI bleeding was 46% higher. Our results suggest that DOACs may be preferable for the majority of older patients with AF, provided they are not at significant risk of a GI bleed. However, these results are based entirely on data from subgroup analyses so should be interpreted cautiously. There is a need for adequately powered research in this patient group.
Mitchell et al. (Wed,) conducted a meta-analysis in Atrial Fibrillation. Direct Oral Anticoagulants vs. Vitamin K Antagonists was evaluated on ischaemic stroke. Direct oral anticoagulants were associated with a slightly lower risk of ischaemic stroke, a 44% lower risk of intracranial haemorrhage, and a 46% higher risk of GI bleeding compared to VKAs.