Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation.

Polymeris, Alexandros A; Macha, Kosmas; Paciaroni, Maurizio; Wilson, Duncan; Koga, Masatoshi; Cappellari, Manuel; Schaedelin, Sabine; Zietz, Annaelle; Peters, Nils; Seiffge, David J.; Haupenthal, David; Gassmann, Luise; De Marchis, Gian Marco; Wang, Ruihao; Gensicke, Henrik; Stoll, Svenja; Thilemann, Sebastian; Avramiotis, Nikolaos S; Bonetti, Bruno; Tsivgoulis, Georgios; ... (2022). Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation. Annals of neurology, 91(1), pp. 78-88. Wiley-Blackwell 10.1002/ana.26267

[img]
Preview
Text
ana.26267.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (1MB) | Preview

OBJECTIVE

To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years.

METHODS

Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (<3 months) aged ≥85 versus <85 years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all-cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk.

RESULTS

In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged ≥85 years and 3,688 (62%) received a DOAC. During 6,874 patient-years follow-up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged ≥85 (HR≥85y  = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR<85y  = 0.79, 95%-CI [0.66, 0.95]) in simple (pinteraction  = 0.129), adjusted (pinteraction  = 0.094) or weighted (pinteraction  = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1).

INTERPRETATION

The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Seiffge, David Julian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0364-5134

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

06 Dec 2021 15:22

Last Modified:

23 Dec 2021 00:13

Publisher DOI:

10.1002/ana.26267

PubMed ID:

34747514

BORIS DOI:

10.48350/161905

URI:

https://boris.unibe.ch/id/eprint/161905

Actions (login required)

Edit item Edit item
Provide Feedback