Department of Cardiovascular Medicine, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan.
Age Ageing. 2022 Jul 1;51(7). doi: 10.1093/ageing/afac146.
the efficacy and safety of direct oral anticoagulants (DOACs) compared with that of warfarin in very old patients with non-valvular atrial fibrillation (NVAF) have been reported in terms of thromboembolisms and bleeding. However, the association of DOAC use and mortality in such patients remains unclear.
this study aimed to investigate the incidence of mortality, as well as thromboembolisms and major bleeding, in very old patients with NVAF using DOACs as compared with warfarin.
we conducted a single-centre historical cohort study of consecutive patients with NVAF aged ≥80 years who used oral anticoagulants. We compared the 5-year outcomes (all-cause mortality, thromboembolism, major bleeding and intracranial haemorrhage) between the DOAC and Warfarin groups.
of 1,676 patients with atrial fibrillation aged 80 years and over, 1,208 with NVAF were included. Propensity score matching provided 461 patients in each group, and the risk of all-cause mortality, thromboembolisms, major bleeding and intracranial haemorrhages was significantly lower in the DOAC group than Warfarin group (hazard ratio [95% confidence interval] for DOAC use, 0.68 [0.54-0.87], 0.31 [0.19-0.53], 0.56 [0.36-0.88], 0.23 [0.10-0.56], log-rank P = 0.002, P < 0.001, P = 0.010, P < 0.001). The mortality rate within 1 year after major bleeding was significantly lower in the DOAC group than Warfarin group (14% versus 38%, P = 0.03), however, that after a thromboembolism was similar between the two groups (33% versus 35%).
patients with NVAF aged ≥80 years and using DOACs had a lower mortality than those using warfarin.
已有研究报告了直接口服抗凝剂（DOAC）与华法林在非瓣膜性心房颤动（NVAF）高龄患者中的疗效和安全性，涉及血栓栓塞和出血事件。然而，DOAC 治疗与此类患者的死亡率之间的关联尚不清楚。
本研究旨在比较 DOAC 与华法林治疗高龄 NVAF 患者的死亡率以及血栓栓塞和大出血事件的发生率。
我们进行了一项单中心回顾性队列研究，纳入了使用口服抗凝剂的年龄≥80 岁 NVAF 连续患者。我们比较了 DOAC 组和华法林组 5 年的结局（全因死亡率、血栓栓塞、大出血和颅内出血）。
在 1676 名年龄≥80 岁的房颤患者中，有 1208 名 NVAF 患者被纳入。通过倾向评分匹配，每组各有 461 名患者，DOAC 组的全因死亡率、血栓栓塞、大出血和颅内出血风险明显低于华法林组（DOAC 使用的风险比[95%置信区间]分别为 0.68[0.54-0.87]、0.31[0.19-0.53]、0.56[0.36-0.88]和 0.23[0.10-0.56]，对数秩检验 P=0.002，P<0.001，P=0.010，P<0.001）。DOAC 组大出血后 1 年内死亡率明显低于华法林组（14%比 38%，P=0.03），而血栓栓塞后两组死亡率相似（33%比 35%）。
年龄≥80 岁、使用 DOAC 的 NVAF 患者的死亡率低于使用华法林的患者。
