Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty
Abstract Background The safety and efficacy of an oral anticoagulant (OAC) treatment and the difference between direct OACs (DOACs) and warfarin in nonsevere frail elderly patients with AF are unclear. Methods This was a retrospective and observational study of 354 patients over 80 years of age with...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-12-01
|
| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/joa3.12231 |
| _version_ | 1819275976513683456 |
|---|---|
| author | Masaya Shinohara Ryou Wada Shintaro Yao Kensuke Yano Katsuya Akitsu Hideki Koike Toshio Kinoshita Hitomi Yuzawa Takeya Suzuki Tadashi Fujino Takanori Ikeda |
| author_facet | Masaya Shinohara Ryou Wada Shintaro Yao Kensuke Yano Katsuya Akitsu Hideki Koike Toshio Kinoshita Hitomi Yuzawa Takeya Suzuki Tadashi Fujino Takanori Ikeda |
| author_sort | Masaya Shinohara |
| collection | DOAJ |
| description | Abstract Background The safety and efficacy of an oral anticoagulant (OAC) treatment and the difference between direct OACs (DOACs) and warfarin in nonsevere frail elderly patients with AF are unclear. Methods This was a retrospective and observational study of 354 patients over 80 years of age with nonsevere frailty who were diagnosed with AF and treated with OACs. Nonsevere frailty was defined as a clinical frailty scale score of <7. Bleeding and thromboembolic events during the OAC treatment were followed up. Results Of 354 patients enrolled, 273 (77.1%) received DOACs and 81 (22.9%) received warfarin. Of 273 patients receiving DOACs, there were 210 (76.9%) prescribed with appropriate doses of DOACs. Of 81 warfarin‐treated patients, 53 (65.4%) were prescribed an appropriate dose of warfarin. During a follow‐up of 33.1 (14.0‐51.0) months, 15 patients (1.5/100 person‐years) had bleeding events and 10 (1.0/100 person‐years) had thromboembolic events while on an OAC treatment. The incidence ratio of bleeding events in patients receiving DOACs was lower than that in those receiving warfarin (1.0/100 person‐years vs 2.9/100 person‐years, hazard ratio [HR]: 0.26, 95% confidence interval [CI]: 0.07‐0.91, P = .036). There was no significant difference in the incidence of thromboembolic events between the DOAC and warfarin treatment groups (0.88/100 person‐years vs 1.4/100 person‐years, HR: 0.63, 95% CI: 0.16‐2.57, P = .52). Conclusions OACs are substantially safe and effective for preventing thromboembolic events in nonsevere frail patients over 80 years of age. Particularly, DOACs can be used more safely than warfarin. |
| first_indexed | 2024-12-23T23:32:53Z |
| format | Article |
| id | doaj.art-2ae32a9f29ff4338a18d5be934afa2e1 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-12-23T23:32:53Z |
| publishDate | 2019-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-2ae32a9f29ff4338a18d5be934afa2e12022-12-21T17:25:58ZengWileyJournal of Arrhythmia1880-42761883-21482019-12-0135679580310.1002/joa3.12231Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailtyMasaya Shinohara0Ryou Wada1Shintaro Yao2Kensuke Yano3Katsuya Akitsu4Hideki Koike5Toshio Kinoshita6Hitomi Yuzawa7Takeya Suzuki8Tadashi Fujino9Takanori Ikeda10Department of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanDepartment of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo JapanAbstract Background The safety and efficacy of an oral anticoagulant (OAC) treatment and the difference between direct OACs (DOACs) and warfarin in nonsevere frail elderly patients with AF are unclear. Methods This was a retrospective and observational study of 354 patients over 80 years of age with nonsevere frailty who were diagnosed with AF and treated with OACs. Nonsevere frailty was defined as a clinical frailty scale score of <7. Bleeding and thromboembolic events during the OAC treatment were followed up. Results Of 354 patients enrolled, 273 (77.1%) received DOACs and 81 (22.9%) received warfarin. Of 273 patients receiving DOACs, there were 210 (76.9%) prescribed with appropriate doses of DOACs. Of 81 warfarin‐treated patients, 53 (65.4%) were prescribed an appropriate dose of warfarin. During a follow‐up of 33.1 (14.0‐51.0) months, 15 patients (1.5/100 person‐years) had bleeding events and 10 (1.0/100 person‐years) had thromboembolic events while on an OAC treatment. The incidence ratio of bleeding events in patients receiving DOACs was lower than that in those receiving warfarin (1.0/100 person‐years vs 2.9/100 person‐years, hazard ratio [HR]: 0.26, 95% confidence interval [CI]: 0.07‐0.91, P = .036). There was no significant difference in the incidence of thromboembolic events between the DOAC and warfarin treatment groups (0.88/100 person‐years vs 1.4/100 person‐years, HR: 0.63, 95% CI: 0.16‐2.57, P = .52). Conclusions OACs are substantially safe and effective for preventing thromboembolic events in nonsevere frail patients over 80 years of age. Particularly, DOACs can be used more safely than warfarin.https://doi.org/10.1002/joa3.12231bleedingdirect oral anticoagulantselderlyfrailwarfarin |
| spellingShingle | Masaya Shinohara Ryou Wada Shintaro Yao Kensuke Yano Katsuya Akitsu Hideki Koike Toshio Kinoshita Hitomi Yuzawa Takeya Suzuki Tadashi Fujino Takanori Ikeda Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty Journal of Arrhythmia bleeding direct oral anticoagulants elderly frail warfarin |
| title | Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty |
| title_full | Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty |
| title_fullStr | Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty |
| title_full_unstemmed | Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty |
| title_short | Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty |
| title_sort | evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty |
| topic | bleeding direct oral anticoagulants elderly frail warfarin |
| url | https://doi.org/10.1002/joa3.12231 |
| work_keys_str_mv | AT masayashinohara evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT ryouwada evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT shintaroyao evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT kensukeyano evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT katsuyaakitsu evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT hidekikoike evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT toshiokinoshita evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT hitomiyuzawa evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT takeyasuzuki evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT tadashifujino evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty AT takanoriikeda evaluationoforalanticoagulantsinatrialfibrillationpatientsover80yearsofagewithnonseverefrailty |