Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Cardiology, Heart Stroke Vascular Center, Mediplex Sejong Hospital, Incheon, Republic of Korea.
PLoS One. 2019 Mar 7;14(3):e0211766. doi: 10.1371/journal.pone.0211766. eCollection 2019.
Elderly patients with atrial fibrillation (AF) are known to have a high risk of stroke and bleeding. We investigated the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in octogenarian patients with non-valvular AF compared with warfarin.
A total of 687 octogenarian patients with AF who were administered NOACs (n = 403) or warfarin (n = 284) for stroke prevention between 2012 and 2016 were included. Thromboembolic (TE) events (stroke or systemic embolism), major bleeding events, and all-cause death were analyzed.
The NOACs group (age 83.4±3.2 years, women 52.4%, CHA2DS2-VASc score 5.0±1.8) comprised 141 dabigatran, 158 rivaroxaban, and 104 apixaban users. Most patients from the NOACs group had been prescribed a reduced dose of medication (85.6%). During 14±18 months of follow-up periods, there were 19 TE events and 18 major bleeding events. Patients with NOAC showed a lower risk of TE (1.84 vs. 2.71 per 100 person-years, hazard ration [HR] 0.134, 95% confidence interval [CI] 0.038-0.479, P = 0.002), major bleeding (1.48 vs. 2.72 per 100 person-years, HR 0.110, 95% CI 0.024-0.493, P = 0.001), and all-cause death (2.57 vs. 3.50 per 100 person-years, HR 0.298, 95% CI 0.108-0.824, P = 0.020).
In octogenarian Asian patients with AF, NOACs might be associated with lower risks of thromboembolic events, major bleeding, and all-cause death than warfarin. Although most patients had received reduced doses, on-label use of NOACs was effective and safe.
已知患有心房颤动（AF）的老年患者发生中风和出血的风险较高。我们研究了与华法林相比，非维生素 K 拮抗剂口服抗凝剂（NOACs）在非瓣膜性 AF 的 80 岁以上患者中的有效性和安全性。
共纳入 2012 年至 2016 年间接受 NOAC（n = 403）或华法林（n = 284）预防中风的 687 例 80 岁以上 AF 患者。分析血栓栓塞（TE）事件（中风或全身性栓塞）、大出血事件和全因死亡。
NOAC 组（年龄 83.4±3.2 岁，女性 52.4%，CHA2DS2-VASc 评分 5.0±1.8）包括 141 例达比加群、158 例利伐沙班和 104 例阿哌沙班使用者。大多数来自 NOAC 组的患者接受了降低剂量的药物治疗（85.6%）。在 14±18 个月的随访期间，发生 19 例 TE 事件和 18 例大出血事件。NOAC 组患者发生 TE 的风险较低（每 100 人年 1.84 与 2.71，风险比 [HR] 0.134，95%置信区间 [CI] 0.038-0.479，P = 0.002）、大出血（每 100 人年 1.48 与 2.72，HR 0.110，95%CI 0.024-0.493，P = 0.001）和全因死亡（每 100 人年 2.57 与 3.50，HR 0.298，95%CI 0.108-0.824，P = 0.020）的风险较低。
在亚洲 80 岁以上患有 AF 的老年患者中，与华法林相比，NOACs 可能与较低的血栓栓塞事件、大出血和全因死亡风险相关。尽管大多数患者接受了降低剂量的药物治疗，但 NOACs 的规范使用是有效且安全的。
