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© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63–0.82; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70–0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76–1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36–0.60; p < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF.

Details

Title
Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
Author
Bonanad, Clara 1   VIAFID ORCID Logo  ; García-Blas, Sergio 2   VIAFID ORCID Logo  ; Javier Torres Llergo 3 ; Fernández-Olmo, Rosa 3 ; Díez-Villanueva, Pablo 4 ; Ariza-Solé, Albert 5 ; Martínez-Sellés, Manuel 6   VIAFID ORCID Logo  ; Raposeiras, Sergio 7 ; Ayesta, Ana 8 ; Bertomeu-González, Vicente 9   VIAFID ORCID Logo  ; Francisco Tarazona Santabalbina 10   VIAFID ORCID Logo  ; Facila, Lorenzo 11 ; Vivas, David 12 ; Gabaldón-Pérez, Ana 13   VIAFID ORCID Logo  ; Bodi, Vicente 14 ; Nuñez, Julio 1 ; Cordero, Alberto 15   VIAFID ORCID Logo 

 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; [email protected] (C.B.); [email protected] (S.G.-B.); [email protected] (A.G.-P.); [email protected] (V.B.); [email protected] (J.N.); Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain; Department of Medicine, Medicine Faculty, 46010 Valencia, Spain 
 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; [email protected] (C.B.); [email protected] (S.G.-B.); [email protected] (A.G.-P.); [email protected] (V.B.); [email protected] (J.N.); Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain; [email protected] (M.M.-S.); [email protected] (V.B.-G.) 
 Cardiology Department, Hospital Universitario de Jaén, 23007 Jaén, Spain; [email protected] (J.T.L.); [email protected] (R.F.-O.) 
 Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; [email protected] 
 Cardiology Department, Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Spain; [email protected] 
 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain; [email protected] (M.M.-S.); [email protected] (V.B.-G.); Cardiology Department, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain 
 Cardiology Department, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain; [email protected] 
 Cardiology Department, Hospital Central de Asturias, 33011 Oviedo, Spain; [email protected] 
 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain; [email protected] (M.M.-S.); [email protected] (V.B.-G.); Cardiology Department, Hospital Universitario de San Joan, 03550 Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernandez, 03550 Alicante, Spain 
10  Geriatrics Department, Hospital Universitario de la Ribera, 46600 Alzira, Spain; [email protected] 
11  Cardiology Department, Hospital General Universitario de Valencia, 46014 Valencia, Spain; [email protected] 
12  Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; [email protected] 
13  Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; [email protected] (C.B.); [email protected] (S.G.-B.); [email protected] (A.G.-P.); [email protected] (V.B.); [email protected] (J.N.); Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain 
14  Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; [email protected] (C.B.); [email protected] (S.G.-B.); [email protected] (A.G.-P.); [email protected] (V.B.); [email protected] (J.N.); Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain; Department of Medicine, Medicine Faculty, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain; [email protected] (M.M.-S.); [email protected] (V.B.-G.) 
15  Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain; [email protected] (M.M.-S.); [email protected] (V.B.-G.); Cardiology Department, Hospital Universitario de San Joan, 03550 Alicante, Spain 
First page
5268
Publication year
2021
Publication date
2021
Publisher
MDPI AG
e-ISSN
20770383
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2602082365
Copyright
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.