Retrospective Comparison of Patients ≥ 80 Years With Atrial Fibrillation Prescribed Either an FDA-Approved Reduced or Full Dose Direct-Acting Oral Anticoagulant. (December 2022)

• Record Type: Journal Article
• Authors: Taoutel, Roy; Ezekowitz, Michael D.; Chaudhry, Usman A.; Weber, Carly; Hassan, Dana; Gracely, Ed J.; Kamareddine, Mohammed H.; Horn, Benjamin I.; Harper, Glenn R.
• Is Part Of: IJC heart & vasculature. Volume 43(2023)
• Publication Date: 2022-12
• Subjects: Atrial fibrillation -- Direct-acting oral anticoagulants -- DOAC -- Elderly; AF atrial fibrillation -- SSE stroke and systemic embolization -- DOACs direct-acting oral anticoagulants -- D150 Dabigatran 150 mg twice daily -- D110 Dabigatran 110 mg twice daily -- D75 Dabigatran 75 mg twice daily -- R20 Rivaroxaban 20 mg daily -- R15 Rivaroxaban 15 mg daily -- A5 Apixaban 5 mg twice daily -- A2.5 Apixaban 2.5 mg twice daily -- CrCl creatinine clearance -- FDA Food and Drug Administration -- BMMSA Bryn Mawr Medical Specialists Association -- CNS central nervous system -- CKD chronic kidney disease -- ESRD end-stage renal disease; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2022.101130
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Direct-acting oral anticoagulants (DOACs) represent the standard for preventing stroke and systemic embolization (SSE) in patients with atrial fibrillation (AF). There is limited information for patients ≥ 80 years. We report a retrospective analysis of AF patients ≥ 80 years prescribed either a US Food and Drug Administration (FDA)-approved reduced (n = 514) or full dose (n = 199) DOAC (Dabigatran, Rivaroxaban, or Apixaban) between January 1st, 2011 (first DOAC commercially available) and May 31st, 2017. The following multivariable differences in baseline characteristics were identified: patients prescribed a reduced dose DOAC were older (p < 0.001), had worse renal function (p = 0.001), were more often prescribed aspirin (p = 0.004) or aspirin and clopidogrel (p < 0.001), and more often had new-onset AF (p = 0.001). SSE and central nervous system (CNS) bleed rates were low and not different (1.02 vs 0 %/yr and 1.45 vs 0.44 %/yr) for the reduced and full dose groups, respectively. For non-CNS bleeds, rates were 10.89 vs 4.15 %/yr (p < 0.001, univariable) for the reduced and full doses, respectively. The mortality rate was 6.24 vs 1.75 %/yr (p = 0.001, univariable) for the reduced and full doses. Unlike the non-CNS bleed rate, mortality rate differences remained significant when adjusted for baseline characteristics. Thus, DOACs in patients ≥ 80 with AF effectively reduce SSE with a low risk of CNS bleeding, independent of DOAC dose. The higher non-CNS bleed rate and not the mortality rate is explained by the higher risk baseline characteristics in the reduced DOAC dose group. Further investigation of the etiology of non-CNS bleeds and mortality is warranted.