Oral anticoagulants in the oldest old with recent stroke and atrial fibrillation

Polymeris, A. A. et al. (2022) Oral anticoagulants in the oldest old with recent stroke and atrial fibrillation. Annals of Neurology, 91(1), pp. 78-88. (doi: 10.1002/ana.26267) (PMID:34747514)

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Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (<3 months) aged ≥85 versus <85 years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all‐cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk. Results: In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged ≥85 years and 3,688 (62%) received a DOAC. During 6,874 patient‐years follow‐up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged ≥85 (HR≥85y = 0.65, 95%‐CI [0.52, 0.81]) and < 85 years (HR<85y = 0.79, 95%‐CI [0.66, 0.95]) in simple (pinteraction = 0.129), adjusted (pinteraction = 0.094) or weighted (pinteraction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient‐years for ICH‐weights 1.5 to 3.1). Interpretation: The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021

Item Type:Articles
Additional Information:We thank all investigators from the participating cohort studies (listed in Table S5) for their contribution to data collection. This study was supported by the Science Fund Rehabilitation of the University Department of Geriatric Medicine Felix Platter Basel, the Stroke Fund and Scientific Fund of the University Hospital Basel. NOACISP-LONGTERM was supported by grants from the Swiss Heart Foundation, Daiichi-Sankyo AG (Switzerland) and Bayer AG (Switzerland). CROMIS-2 was jointly funded by the Stroke Association and the British Heart Foundation and supported by researchers at the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre. UCL acted as the Sponsor for CROMIS-2, with responsibility for the conduct and management of the study. SAMURAI-NVAF was supported by a Grant-in-Aid (H23-Junkanki-Ippan-010) from the Ministry of Health, Labour and Welfare, Japan and an Intramural Research Fund (H23-4-3 and H28-4-1) for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center. RAF/RAF-DOAC has been supported by the Italian Ministry of Health Ricerca Corrente – IRCCS MultiMedica. Open access funding provided by Universitat Basel.
Glasgow Author(s) Enlighten ID:Muir, Professor Keith
Authors: Polymeris, A. A., Macha, K., Paciaroni, M., Wilson, D., Koga, M., Cappellari, M., Schaedelin, S., Zietz, A., Peters, N., Seiffge, D. J., Haupenthal, D., Gassmann, L., De Marchis, G. M., Wang, R., Gensicke, H., Stoll, S., Thilemann, S., Avramiotis, N. S., Bonetti, B., Tsivgoulis, G., Ambler, G., Alberti, A., Yoshimura, S., Brown, M. M., Shiozawa, M., Lip, G. Y. H., Venti, M., Acciarresi, M., Tanaka, K., Mosconi, M. G., Takagi, M., Jäger, R. H., Muir, K., Inoue, M., Schwab, S., Bonati, L. H., Lyrer, P. A., Toyoda, K., Caso, V., Werring, D. J., Kallmünzer, B., and Engelter, S. T.
College/School:College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
Journal Name:Annals of Neurology
ISSN (Online):1531-8249
Published Online:29 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Annals of Neurology 91(1): 78-88
Publisher Policy:Reproduced under a Creative Commons License

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