Published in:
01-12-2019 | Stroke | Original Article
Oral anticoagulant use and clinical outcomes in elderly Japanese patients: findings from the SAKURA AF Registry
Authors:
Toshihiko Nishida, Yasuo Okumura, Katsuaki Yokoyama, Naoya Matsumoto, Eizo Tachibana, Keiichiro Kuronuma, Koji Oiwa, Michiaki Matsumoto, Toshiaki Kojima, Shoji Hanada, Kazumiki Nomoto, Kazumasa Sonoda, Ken Arima, Rikitake Kogawa, Fumiyuki Takahashi, Tomobumi Kotani, Kimie Ohkubo, Seiji Fukushima, Satoru Itou, Kunio Kondo, Masaaki Chiku, Yasumi Ohno, Motoyuki Onikura, Atsushi Hirayama, for the SAKURA AF Registry Investigators
Published in:
Heart and Vessels
|
Issue 12/2019
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Abstract
Direct-acting oral anticoagulants (DOACs) are widely used in aged Japanese patients with atrial fibrillation (AF), but outcome data for such patients are limited. We compared outcomes between 1895 (58.5%) patients aged < 75 years (non-elderly), 1078 (33.3%) 75–84 years (elderly) and 264 (8.2%) ≥ 85 years (very elderly) enrolled in a prospective multicenter registry. Kaplan–Meier analysis (median follow-up: 39.3 months) revealed a significantly high incidence of stroke/systemic embolism (SE) among the very elderly relative to that among the non-elderly or elderly (3.2 vs. 1.2 and 1.5 events per 100 patient-years, p < 0.001). Major bleeding in the non-elderly group was significantly infrequent relative to that among the elderly or very elderly group (1.1 vs. 1.6 vs. 1.8 events, p = 0.033). After multivariate adjustment, the stroke/SE incidence was comparable between DOAC and warfarin users, regardless of age, but major bleeding decreased significantly among very elderly DOAC users (adjusted HR 0.220, 95% CI 0.042–0.920). The greater increasing incidence of stroke/SE than major bleeding as patients age suggests that stroke prevention should outweigh the bleeding risk when anticoagulants are being considered for aged patients. Our data indicated that DOACs can be a therapeutic option for stroke prevention in very elderly patients.