Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis

Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoin...

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Autores principales:	Clara Bonanad, Sergio García-Blas, Javier Torres Llergo, Rosa Fernández-Olmo, Pablo Díez-Villanueva, Albert Ariza-Solé, Manuel Martínez-Sellés, Sergio Raposeiras, Ana Ayesta, Vicente Bertomeu-González, Francisco Tarazona Santabalbina, Lorenzo Facila, David Vivas, Ana Gabaldón-Pérez, Vicente Bodi, Julio Nuñez, Alberto Cordero
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	elderly acute coronary syndrome myocardial infarction vitamin-K antagonist direct oral anticoagulants Medicine R
Acceso en línea:	https://doaj.org/article/2fc5cdb571224da6869f5687b588da90
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spelling	oai:doaj.org-article:2fc5cdb571224da6869f5687b588da902021-11-25T18:01:05ZDirect Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis10.3390/jcm102252682077-0383https://doaj.org/article/2fc5cdb571224da6869f5687b588da902021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5268https://doaj.org/toc/2077-0383Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63–0.82; <i>p</i> < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70–0.96; <i>p</i> = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; <i>p</i> = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76–1.53; <i>p</i> = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36–0.60; <i>p</i> < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF.Clara BonanadSergio García-BlasJavier Torres LlergoRosa Fernández-OlmoPablo Díez-VillanuevaAlbert Ariza-SoléManuel Martínez-SellésSergio RaposeirasAna AyestaVicente Bertomeu-GonzálezFrancisco Tarazona SantabalbinaLorenzo FacilaDavid VivasAna Gabaldón-PérezVicente BodiJulio NuñezAlberto CorderoMDPI AGarticleelderlyacute coronary syndromemyocardial infarctionvitamin-K antagonistdirect oral anticoagulantsMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5268, p 5268 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	elderly acute coronary syndrome myocardial infarction vitamin-K antagonist direct oral anticoagulants Medicine R
spellingShingle	elderly acute coronary syndrome myocardial infarction vitamin-K antagonist direct oral anticoagulants Medicine R Clara Bonanad Sergio García-Blas Javier Torres Llergo Rosa Fernández-Olmo Pablo Díez-Villanueva Albert Ariza-Solé Manuel Martínez-Sellés Sergio Raposeiras Ana Ayesta Vicente Bertomeu-González Francisco Tarazona Santabalbina Lorenzo Facila David Vivas Ana Gabaldón-Pérez Vicente Bodi Julio Nuñez Alberto Cordero Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
description	Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63–0.82; <i>p</i> < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70–0.96; <i>p</i> = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; <i>p</i> = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76–1.53; <i>p</i> = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36–0.60; <i>p</i> < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF.
format	article
author	Clara Bonanad Sergio García-Blas Javier Torres Llergo Rosa Fernández-Olmo Pablo Díez-Villanueva Albert Ariza-Solé Manuel Martínez-Sellés Sergio Raposeiras Ana Ayesta Vicente Bertomeu-González Francisco Tarazona Santabalbina Lorenzo Facila David Vivas Ana Gabaldón-Pérez Vicente Bodi Julio Nuñez Alberto Cordero
author_facet	Clara Bonanad Sergio García-Blas Javier Torres Llergo Rosa Fernández-Olmo Pablo Díez-Villanueva Albert Ariza-Solé Manuel Martínez-Sellés Sergio Raposeiras Ana Ayesta Vicente Bertomeu-González Francisco Tarazona Santabalbina Lorenzo Facila David Vivas Ana Gabaldón-Pérez Vicente Bodi Julio Nuñez Alberto Cordero
author_sort	Clara Bonanad
title	Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_short	Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_full	Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_fullStr	Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_full_unstemmed	Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_sort	direct oral anticoagulants versus warfarin in octogenarians with nonvalvular atrial fibrillation: a systematic review and meta-analysis
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/2fc5cdb571224da6869f5687b588da90
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Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis

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