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Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation: A global federated health network analysis.
- Source :
- Journal of the American Geriatrics Society; Aug2022, Vol. 70 Issue 8, p2386-2392, 7p
- Publication Year :
- 2022
-
Abstract
- Background: The objective of this study was to determine associations between use of oral anticoagulation (OAC) and stroke and bleeding‐related outcomes for older people ≥80 years with atrial fibrillation (AF), and to determine trends over time in prescribing of OAC for this population. Methods: A retrospective cohort study was conducted. People aged ≥80 years with AF receiving (1) no OAC; (2) warfarin; or (3) a non‐vitamin‐K antagonist oral anticoagulant (NOAC) between 2011 and 2019 were included. Propensity score matching was used to balance cohorts (no OAC, warfarin or a NOAC) on characteristics including age, sex, ethnicity, and co‐morbidities. Cox proportional hazard models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The proportion of people aged ≥80 years receiving any OAC increased from 32.4% (n = 27,647) in 2011 to 43.6% (n = 110,412) in 2019. After propensity score matching, n = 169,067 individuals were included in the cohorts receiving no OAC or a NOAC. Compared to no OAC, participants receiving a NOAC had a lower risk of incident dementia (hazHR 0.68, 95% CI 0.65–0.71), all‐cause mortality (HR 0.49, 95% CI 0.48–0.50), first‐time ischaemic stroke (HR 0.87, 95% CI 0.83–0.91), and a higher risk of major bleeding (HR 1.08, 95% CI 1.05–1.11). Compared to participants receiving warfarin, participants receiving a NOAC had a lower risk of dementia (HR 0.90, 95% CI: 0.86–0.93), all‐cause mortality (HR 0.74, 95% CI: 0.72–0.76), ischaemic stroke (HR 0.86, 95% CI: 0.82–0.90) and major bleeding (HR 0.88, 95% CI: 0.85–0.90). Similar results were observed when only including people with additional bleeding risk factors. Conclusions: The proportion of people aged ≥80 years receiving OAC has increased since the introduction of NOACs, but remains low. Use of a NOAC was associated with improved outcomes compared to warfarin, and compared to no OAC, except for a small but statistically significant higher risk of major bleeding. [ABSTRACT FROM AUTHOR]
- Subjects :
- WARFARIN
HEMORRHAGE risk factors
STROKE
CONFIDENCE intervals
ORAL drug administration
ISCHEMIC stroke
AGE distribution
MORTALITY
ATRIAL fibrillation
ANTICOAGULANTS
RETROSPECTIVE studies
RISK assessment
TREATMENT effectiveness
SEX distribution
COMPARATIVE studies
MEDICAL prescriptions
ETHNIC groups
HEMORRHAGE
LONGITUDINAL method
PROPORTIONAL hazards models
OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 00028614
- Volume :
- 70
- Issue :
- 8
- Database :
- Complementary Index
- Journal :
- Journal of the American Geriatrics Society
- Publication Type :
- Academic Journal
- Accession number :
- 158527897
- Full Text :
- https://doi.org/10.1111/jgs.17884