University of Campania "Luigi Vanvitelli," Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy.
J Cardiovasc Pharmacol. 2019 Apr;73(4):207-214. doi: 10.1097/FJC.0000000000000661.
Atrial fibrillation is the most common arrhythmia in clinical practice, and age is one of the strongest predictors/risk factors for ischemic stroke in patients with atrial fibrillation. Elderly patients, in particular patients aged 80 years and older, are at higher risk of both ischemic and bleeding events compared with younger patients. Vitamin K antagonists (VKAs) reduce the risk of ischemic stroke, especially in the elderly, but increase the bleeding risk. In addition, frequent international normalized ratio monitoring is needed to ensure the optimal level of anticoagulation. Furthermore, VKAs have multiple drug and food interactions. Direct oral anticoagulants (DOACs) have recently emerged as alternatives to VKAs and are gradually increasing their popularity mainly because of their fewer drug and food interactions and ease of use. Their effectiveness and safety have been well-established in the general population, but the benefit in the very elderly (≥80 years old) is still unclear. Data about the safety and the effectiveness of DOACs in patients older than 75 years are available in literature, but the evidences of the use of DOACs in patients aged 80 years and older are lacking. This review aims to give light to the differences, in terms of benefits and safety, of the DOACs in this subset of patients.
心房颤动是临床实践中最常见的心律失常，年龄是心房颤动患者发生缺血性卒中的最强预测因素/危险因素之一。与年轻患者相比，老年患者，特别是 80 岁及以上的老年患者，缺血和出血事件的风险更高。维生素 K 拮抗剂（VKA）可降低缺血性卒中的风险，尤其是在老年人中，但会增加出血风险。此外，需要频繁监测国际标准化比值，以确保抗凝的最佳水平。此外，VKA 有多种药物和食物相互作用。直接口服抗凝剂（DOAC）最近已成为 VKA 的替代品，并因其较少的药物和食物相互作用以及使用方便而逐渐受到欢迎。其在普通人群中的有效性和安全性已得到充分证实，但在非常高龄（≥80 岁）人群中的获益仍不清楚。关于 DOAC 在 75 岁以上患者中的安全性和有效性的数据在文献中已有报道，但缺乏 80 岁及以上患者使用 DOAC 的证据。本综述旨在阐明 DOAC 在这部分患者中的获益和安全性方面的差异。
