Dataset Information

Clinical Outcomes of Direct Oral Anticoagulants and Warfarin in Japanese Patients with Atrial Fibrillation Aged???85 Years: A Single-Center Observational Study.

ABSTRACT: BACKGROUND:Increasing age is associated with an increase in stroke in patients with nonvalvular atrial fibrillation (NVAF). Elderly patients have several comorbidities and increased bleeding risk. OBJECTIVE:The aim of this study was to evaluate the clinical outcomes of Japanese patients with NVAF aged???85 years who were treated with direct oral anticoagulants (DOACs) or warfarin. METHODS:We retrospectively studied the records of 358 patients with NVAF aged???85 years who had taken DOACs or warfarin between 2014 and 2018. The primary endpoints were the first occurrences of thromboembolic and bleeding events and death. The secondary endpoint was the discontinuation of oral anticoagulation (OAC) therapy. RESULTS:During a median follow-up period of 17 months, 24 patients died. The incidence (per 100 patient-years [PY]) of thromboembolic events was 1.8 in patients treated with DOACs and 2.2 in those treated with warfarin (adjusted subdistribution hazard ratio [SHR] 0.69; 95% confidence interval [CI] 0.23-2.12 in a competing model), and the incidence of major bleeding events was 3.1 and 4.2 in patients treated with DOACs and warfarin, respectively (adjusted SHR 0.95; 95% CI 0.32-2.86). The most common cause of bleeding events was gastrointestinal bleeding. A total of 33 patients permanently discontinued OAC therapy, at a median age of 89 years and with no differences between DOACs and warfarin. The most common reason for discontinuing OAC therapy was bleeding events. CONCLUSION:Our results revealed that the incidences of thromboembolism and major bleeding among patients with NVAF aged???85 years were similar for those treated with DOACs and those treated with warfarin. Approximately 10% of patients permanently discontinued OAC therapy.

SUBMITTER: Naganuma M

PROVIDER: S-EPMC7581660 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Clinical Outcomes of Direct Oral Anticoagulants and Warfarin in Japanese Patients with Atrial Fibrillation Aged ≥ 85 Years: A Single-Center Observational Study.

Naganuma Miyoko M Shiga Tsuyoshi T Hagiwara Nobuhisa N

Drugs - real world outcomes 20201201 4

<h4>Background</h4>Increasing age is associated with an increase in stroke in patients with nonvalvular atrial fibrillation (NVAF). Elderly patients have several comorbidities and increased bleeding risk.<h4>Objective</h4>The aim of this study was to evaluate the clinical outcomes of Japanese patients with NVAF aged ≥ 85 years who were treated with direct oral anticoagulants (DOACs) or warfarin.<h4>Methods</h4>We retrospectively studied the records of 358 patients with NVAF aged ≥ 85 years who h ...[more]

PMID: 32776274

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Project description:BackgroundPrevious studies examining the use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) have largely focused on patients newly initiating therapy. Little is known about the prevalence/patterns of switching to DOACs among AF patients initially treated with warfarin.HypothesisTo examine patterns of anticoagulation among patients chronically managed with warfarin upon the availability of DOACs and identify patient/practice-level factors associated with switching from chronic warfarin therapy to a DOAC.MethodsProspective cohort study of AF patients in the NCDR PINNACLE registry prescribed warfarin between May 1, 2008 and May 1, 2015. Patients were followed at least 1 year (median length of follow-up 375 days, IQR 154-375) through May 1, 2016 and stratified as follows: continued warfarin, switched to DOAC, or discontinued anticoagulation. To identify significant predictors of switching, a three-level multivariable hierarchical regression was developed.ResultsAmong 383 008 AF patients initially prescribed warfarin, 16.3% (n = 62 620) switched to DOACs, 68.8% (n = 263 609) continued warfarin, and 14.8% (n = 56 779) discontinued anticoagulation. Among those switched, 37.6% received dabigatran, 37.0% rivaroxaban, 24.4% apixaban, and 1.0% edoxaban. Switched patients were more likely to be younger, women, white, and have private insurance (all P < .001). Switching was less likely with increased stroke risk (OR, 0.92; 95%CI, 0.91-0.93 per 1-point increase CHA2 DS2 -VASc), but more likely with increased bleeding risk (OR, 1.12; 95%CI, 1.10-1.13 per 1-point increase HAS-BLED). There was substantial variation at the practice-level (MOR, 2.33; 95%CI, 2.12-2.58) and among providers within the same practice (MOR, 1.46; 95%CI, 1.43-1.49).ConclusionsAmong AF patients treated with warfarin between October 1, 2010 and May 1, 2016, one in six were switched to DOACs, with differences across sociodemographic/clinical characteristics and substantial practice-level variation. In the context of current guidelines which favor DOACs over warfarin, these findings help benchmark performance and identify areas of improvement.

Project description:BackgroundDirect-acting oral anticoagulants (DOACs) have demonstrated superior efficacy in preventing stroke and death compared with warfarin in patients with atrial fibrillation (AF), but their influence on dementia risk remains unclear.ObjectivesThe purpose of this study was to evaluate the relative risks of dementia in DOAC vs warfarin in patients with AF.MethodsAn electronic literature search was conducted to retrieve studies reporting comparisons of dementia incidence between patients treated with DOACs and warfarin for AF. HRs and 95% CI were pooled in a random-effects meta-analysis. Meta-regression was performed to identify prognostic baseline variables. Network meta-analysis was performed to determine dementia risk between individual DOACs and warfarin.ResultsTen studies (n = 342,624) were retrieved. DOAC was associated with a significantly lower risk of developing dementia compared with warfarin (HR: 0.88; 95% CI: 0.80-0.98; P = 0.017; I2 = 75%); significance was also seen in Asian patients (HR: 0.81; 95% CI: 0.68-0.86) but not non-Asian patients. Subgroup analyses of propensity score-matched studies and patients aged 65-75 years showed similar significance, but not for patients aged ≥75 years. Meta-regression found that a lower mean age corresponded to significantly greater favoring of DOAC over warfarin. Network meta-analysis found significant reductions in dementia risk over warfarin for rivaroxaban (HR: 0.854; 95% CI: 0.763-0.955), apixaban (HR: 0.881; 95% CI: 0.778-0.997), and dabigatran (HR: 0.871; 95% CI: 0.770-0.987); the highest-ranked treatment based on P scores was edoxaban.ConclusionsThe use of DOAC in AF significantly reduces dementia risk compared with warfarin, particularly in Asian patients. The possible reversal of this effect with increasing age merits further randomized trials with long-term follow-up. (Dementia Risk of Direct Oral Anticoagulants Versus Warfarin for Atrial Fibrillation: A Systematic Review and Meta-Analysis; CRD42022365634).

Dataset Information

Clinical Outcomes of Direct Oral Anticoagulants and Warfarin in Japanese Patients with Atrial Fibrillation Aged???85 Years: A Single-Center Observational Study.

Publications

Clinical Outcomes of Direct Oral Anticoagulants and Warfarin in Japanese Patients with Atrial Fibrillation Aged ≥ 85 Years: A Single-Center Observational Study.

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