Non‐vitamin K vs vitamin K oral anticoagulants in patients aged > 80 year with atrial fibrillation and low body weight

• Published in: European journal of clinical investigation 2020-11, Vol.50 (11), p.e13335-n/a
• Main Authors: Russo, Vincenzo, Attena, Emilio, Di Maio, Marco, Carbone, Andreina, Parisi, Valentina, Rago, Anna, Grieco, Fabrizio Vincenzo, Buonauro, Agostino, Golino, Paolo, Nigro, Gerardo
• Format: Article
• Language: English
• Subjects: Anticoagulants; atrial fibrillation; Bleeding; Body weight; Cardiac arrhythmia; Chronic obstructive pulmonary disease; Diabetes mellitus; direct oral anticoagulant; elderly; Fibrillation; low body weight; Mortality; Phylloquinone; Risk analysis; Risk factors; stroke prevention; Vitamin K
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/eci.13335

Background Octogenarian patients are at high risk of both ischaemic and bleeding events, and the low body weight is considered a risk factor for major bleeding in atrial fibrillation (AF) patients on anticoagulation therapy. The aim of our study was to compare the safety and effectiveness of NOACs versus well‐controlled VKA therapy among patients aged > 80 year with AF and low body weight in real‐life setting. Methods Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874). From this, we selected AF patients aged ≥ 80 years and weighted ≤ 60 kg who received NOACs or VKAs treatment (only those with a time in therapeutic range > 70%). 279 patients (136 in NOAC group and 143 in VKA group) were selected. Results A total of 71 patients (17 in NOAC vs 54 in VKA group) died during the follow‐up. The incidence rate of all‐cause mortality was 27.70 per 100 person‐years (14.91 in NOAC vs 37.94 in VKA group, adjusted hazard ratio 0.43; 95% CI 0.25 to 0.975; P = .003). 22 patients (9 in NOAC vs 13 in VKA group, P = .6) had major bleeding events. Diabetes mellitus, COPD and age resulted positively associated with death, whereas NOACs, parossistic AF and weight negatively associated with mortality. Conclusions Our real‐world data might suggest the safe and efficacy use of NOACs in this setting of population, justified by a reduction in overall mortality over VKAs. Further studies are needed to confirm these data.