Net Clinical Benefit of NOACs vs. VKAs in Elderly Patients with Atrial Fibrillation: a Pooled Analysis from the Real-World PREFER in AF and PREFER in AF PROLONGATION Registries

0493047 - ÚI 2019 GB eng A - Abstrakt
Cavallari, I. - Patti, G. - Pecen, Ladislav - Lucerna, M. - Huber, K. - Rohla, M. - Renda, G. - Siller-Matula, J. M. - Ricci, F. - Kirchhof, P. - De Caterina, R.
Net Clinical Benefit of NOACs vs. VKAs in Elderly Patients with Atrial Fibrillation: a Pooled Analysis from the Real-World PREFER in AF and PREFER in AF PROLONGATION Registries.
European Heart Journal. Roč. 39, Suppl. 1 (2018), č. článku P3837. ISSN 0195-668X. E-ISSN 1522-9645
Klíčová slova: atrial fibrillation * elderly * vitamin k antagonists * direct oral anticoagulants

BACKGROUND: The risks of thromboembolic and hemorrhagic events in patients with atrial fibrillation (AF) increase with age; therefore, in the elderly net clinical benefit analyses of anticoagulants are crucial to guide treatment. PURPOSE: To evaluate 1-year clinical outcomes with non-vitamin K antagonist and vitamin K antagonist oral anticoagulants (NOACs versus VKAs) in elderly AF patients (=>75 years) enrolled in a prospective European registry. METHODS: Data on 3,852 elderly patients were pooled from the PREFER in AF and PREFER in AF PROLONGATION registries. The primary outcome was the incidence of the net composite endpoint, including major bleeding and ischemic cardiovascular events while on treatment with NOACs (N=1,556) compared to VKAs (N=2,269). RESULTS: The rates of the net composite endpoint were 6.6%/year with NOACs versus 9.1%/year with VKAs (adjOR 0.64, 95% CI 0.48–0.86; p=0.003). Treatment with a NOAC was associated with a lower rate of major bleeding compared with VKA (adjOR 0.52, 0.33–0.83; p=0.006; Figure). Ischemic events were nominally lower, too (adjOR 0.71, 0.50–0.99; p=0.048; Figure). The difference in major bleeding associated with NOACs compared with VKAs was even greater in elderly patients with low body mass index (BMI, adjOR 0.40), and greatest (adjOR 0.33) in patients aged => 85 years. CONCLUSIONS: Our real-world data indicate that, compared with VKAs, NOAC use is associated with a better net clinical benefit in elderly patients with AF, primarily due to lower rates of major bleeding. The improved bleeding outcome with NOACs was even higher in elderly patients with low BMI and in those with more advanced age. ACKNOWLEDGEMENT/FUNDING: Daiichi Sankyo Europe.
Trvalý link: http://hdl.handle.net/11104/0286514