Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation. Issue 1 (29th November 2021)

• Record Type: Journal Article
• Authors: 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; Ambler, Gareth; Alberti, Andrea; Yoshimura, Sohei; Brown, Martin M.; Shiozawa, Masayuki; Lip, Gregory Y. H.; Venti, Michele; Acciarresi, Monica; Tanaka, Kanta; Mosconi, Maria Giulia; Takagi, Masahito; Jäger, Rolf H.; Muir, Keith; Inoue, Manabu; Schwab, Stefan; Bonati, Leo H.; Lyrer, Philippe A.; Toyoda, Kazunori; Caso, Valeria; Werring, David J.; Kallmünzer, Bernd; Engelter, Stefan T.;
• Other Names: Engelter Stefan T investigator.; Lyrer Philippe A investigator.; Bonati Leo H investigator.; Seiffge David J investigator.; Traenka Christopher investigator.; Polymeris Alexandros A investigator.; Zietz Annaelle investigator.; Peters Nils investigator.; De Marchis Gian Marco investigator.; Thilemann Sebastian investigator.; Avramiotis Nikolaos S investigator.; Gensicke Henrik investigator.; Hert Lisa investigator.; Wagner Benjamin investigator.; Schaub Fabian investigator.; Meya Louisa investigator.; Fladt Joachim investigator.; Dittrich Tolga investigator.; Fisch Urs investigator.; Macha Kosmas investigator.; Haupenthal David investigator.; Gassmann Luise investigator.; Wang Ruihao investigator.; Stoll Svenja investigator.; Schwab Stefan investigator.; Volbers Bastian investigator.; Siedler Gabriela investigator.; Kallmünzer Bernd investigator.; Cappellari Manuel investigator.; Bonetti Bruno investigator.; Bovi Paolo investigator.; Tomelleri Giampaolo investigator.; Micheletti Nicola investigator.; Zivelonghi Cecilia investigator.; Emiliani Andrea investigator.; Parry‐Jones Adrian investigator.; Patterson Chris investigator.; Price Christopher investigator.; Elmarimi Abduelbaset investigator.; Parry Anthea investigator.; Nallasivam Arumug investigator.; Nor Azlisham Mohd investigator.; Esis Bernard investigator.; Bruce David investigator.; Bhaskaran Biju investigator.; Roffe Christine investigator.; Cullen Claire investigator.; Holmes Clare investigator.; Cohen David investigator.; Hargroves David investigator.; Mangion David investigator.; Chadha Dinesh investigator.; Vahidassr Djamil investigator.; Manawadu Dulka investigator.; Giallombardo Elio investigator.; Warburton Elizabeth investigator.; Flossman Enrico investigator.; Gunathilagan Gunaratam investigator.; Proschel Harald investigator.; Emsley Hedley investigator.; Anwar Ijaz investigator.; Burger Ilse investigator.; Okwera James investigator.; Putterill Janet investigator.; O'Connell Janice investigator.; Bamford John investigator.; Corrigan John investigator.; Scott Jon investigator.; Birns Jonathan investigator.; Kee Karen investigator.; Saastamoinen Kari investigator.; Pasco Kath investigator.; Dani Krishna investigator.; Sekaran Lakshmanan investigator.; Choy Lillian investigator.; Iveson Liz investigator.; Mamun Maam investigator.; Sajid Mahmud investigator.; Cooper Martin investigator.; Burn Matthew investigator.; Smith Matthew investigator.; Power Michael investigator.; Davis Michelle investigator.; Smyth Nigel investigator.; Veltkamp Roland investigator.; Sharma Pankaj investigator.; Guyler Paul investigator.; O'Mahony Paul investigator.; Wilkinson Peter investigator.; Datta Prabel investigator.; Aghoram Prasanna investigator.; Marsh Rachel investigator.; Luder Robert investigator.; Meenakishundaram Sanjeevikumar investigator.; Subramonian Santhosh investigator.; Leach Simon investigator.; Ispoglou Sissi investigator.; Andole Sreeman investigator.; England Timothy investigator.; Manoj Aravindakshan investigator.; Harrington Frances investigator.; Rehman Habib investigator.; Sword Jane investigator.; Staals Julie investigator.; Mahawish Karim investigator.; Harkness Kirsty investigator.; Shaw Louise investigator.; McCormich Michael investigator.; Sprigg Nikola investigator.; Mansoor Syed investigator.; Krishnamurthy Vinodh investigator.; Giustozzi Michela investigator.; Acciarresi Monica investigator.; Agnelli Giancarlo investigator.; Caso Valeria investigator.; Becattini Cecilia investigator.; Alberti Andrea investigator.; Venti Michele investigator.; D'Amore Cataldo investigator.; Mosconi Maria Giulia investigator.; Cimini Ludovica Anna investigator.; Paciaroni Maurizio investigator.; Bandini Fabio investigator.; Tsivgoulis Georgios investigator.; Liantinioti Chrissoula investigator.; Chondrogianni Maria investigator.; Yaghi Shadi investigator.; Furie Karen L. investigator.; Tadi Prasanna investigator.; Zedde Marialuisa investigator.; Abdul‐Rahim Azmil H investigator.; Lees Kennedy R investigator.; Bovi Paolo investigator.; Carletti Monica investigator.; Rigatelli Alberto investigator.; Cappellari Manuel investigator.; Putaala Jukka investigator.; Tomppo Liisa investigator.; Tatlisumak Turgut investigator.; Marcheselli Simona investigator.; Pezzini Alessandro investigator.; Poli Loris investigator.; Padovani Alessandro investigator.; Vannucchi Vieri investigator.; Masotti Luca investigator.; Sohn Sung‐Il investigator.; Lorenzini Gianni investigator.; Tassi Rossana investigator.; Guideri Francesca investigator.; Acampa Maurizio investigator.; Martini Giuseppe investigator.; Ntaios George investigator.; Athanasakis George investigator.; Makaritsis Konstantinos investigator.; Karagkiozi Efstathia investigator.; Vadikolias Konstantinos investigator.; Mumoli Nicola investigator.; Galati Franco investigator.; Sacco Simona investigator.; Tiseo Cindy investigator.; Corea Francesco investigator.; Ageno Walter investigator.; Bellesini Marta investigator.; Colombo Giovanna investigator.; Silvestrelli Giorgio investigator.; Ciccone Alfonso investigator.; Lanari Alessia investigator.; Scoditti Umberto investigator.; Denti Licia investigator.; Mancuso Michelangelo investigator.; Maccarrone Miriam investigator.; Ulivi Leonardo investigator.; Orlandi Giovanni investigator.; Giannini Nicola investigator.; Tassinari Tiziana investigator.; De Lodovici Maria Luisa investigator.; Rueckert Christina investigator.; Baldi Antonio investigator.; Toni Danilo investigator.; Letteri Federica investigator.; Pieroni Alessio investigator.; Giuntini Martina investigator.; Lotti Enrico Maria investigator.; Flomin Yuriy investigator.; Kargiotis Odysseas investigator.; Karapanayiotides Theodore investigator.; Monaco Serena investigator.; Baronello Mario Maimone investigator.; Csiba Laszló investigator.; Szabó Lilla investigator.; Chiti Alberto investigator.; Giorli Elisa investigator.; Del Sette Massimo investigator.; Imberti Davide investigator.; Zabzuni Dorjan investigator.; Doronin Boris investigator.; Volodina Vera investigator.; Michel Patrik investigator.; Vanacker Peter investigator.; Barlinn Kristian investigator.; Pallesen Lars‐Peder investigator.; Barlinn Jessica investigator.; Deleu Dirk investigator.; Melikyan Gayane investigator.; Ibrahim Faisal investigator.; Akhtar Naveed investigator.; Gourbali Vanessa investigator.; Todo Kenichi investigator.; Kimura Kazumi investigator.; Shibazaki Kensaku investigator.; Yagita Yoshiki investigator.; Furui Eisuke investigator.; Itabashi Ryo investigator.; Terasaki Tadashi investigator.; Shiokawa Yoshiaki investigator.; Hirano Teruyuki investigator.; Suzuki Rieko investigator.; Kamiyama Kenji investigator.; Nakagawara Jyoji investigator.; Takizawa Shunya investigator.; Homma Kazunari investigator.; Okuda Satoshi investigator.; Okada Yasushi investigator.; Maeda Koichiro investigator.; Kameda Tomoaki investigator.; Kario Kazuomi investigator.; Nagakane Yoshinari investigator.; Hasegawa Yasuhiro investigator.; Akiyama Hisanao investigator.; Shibuya Satoshi investigator.; Mochizuki Hiroshi investigator.; Ito Yasuhiro investigator.; Nakashima Takahiro investigator.; Matsuoka Hideki investigator.; Takamatsu Kazuhiro investigator.; Nishiyama Kazutoshi investigator.; Tanaka Kanta investigator.; Endo Kaoru investigator.; Miyagi Tetsuya investigator.; Osaki Masato investigator.; Kobayashi Junpei investigator.; Okata Takuya investigator.; Tanaka Eijiro investigator.; Sakamoto Yuki investigator.; Tokunaga Keisuke investigator.; Takizawa Hotake investigator.; Takasugi Junji investigator.; Matsubara Soichiro investigator.; Higashida Kyoko investigator.; Matsuki Takayuki investigator.; Kinoshita Naoto investigator.; Shiozawa Masayuki investigator.; Ide Toshihiro investigator.; Yoshimoto Takeshi investigator.; Ando Daisuke investigator.; Fujita Kyohei investigator.; Kumamoto Masaya investigator.; Kamimura Teppei investigator.; Kikuno Muneaki investigator.; Mizoguchi Tadataka investigator.; Sato Takeo investigator.;
• Is Part Of: Annals of neurology. Volume 91:Issue 1(2022)
• Page Start: 78
• Page End: 88
• Publication Date: 2021-11-29
• Subjects: Neurology -- Periodicals; Pediatric neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 616.8
• DOI: 10.1002/ana.26267
• Languages: English
• ISSNs: 0364-5134

Abstract

Abstract : 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 2022;91:78–88