Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation

Polymeris AA, Macha K, Paciaroni M, Wilson D, Koga M, Cappellari M, Schaedelin S, Zietz A, Peters N, Seiffge DJ, Haupenthal D, Gaßmann L, De Marchis GM, Wang R, Gensicke H, Stoll S, Thilemann S, Avramiotis NS, Bonetti B, Tsivgoulis G, Ambler G, Alberti A, Yoshimura S, Brown MM, Shiozawa M, Lip GYH, Venti M, Acciarresi M, Tanaka K, Mosconi MG, Takagi M, Jager RH, Muir K, Inoue M, Schwab S, Bonati LH, Lyrer PA, Toyoda K, Caso V, Werring DJ, Kallmünzer B, Engelter ST (2021)

Publication Type: Journal article

Publication year: 2021

Journal

DOI: 10.1002/ana.26267

Abstract

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 (p(interaction) = 0.129), adjusted (p(interaction) = 0.094) or weighted (p(interaction) = 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

Authors with CRIS profile

Involved external institutions

Universitätsspital Basel Switzerland (CH) Istituto di ricovero e cura a carattere scientifico (IRCCS) Italy (IT) University College London (UCL) United Kingdom (GB) National Cerebral and Cardiovascular Center Japan (JP) University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) Italy (IT) Universität Basel Switzerland (CH) National and Kapodistrian University of Athens Greece (GR) Università degli Studi di Perugia Italy (IT) The University of Liverpool United Kingdom (GB) University of Glasgow United Kingdom (GB)

How to cite

APA:

Polymeris, A.A., Macha, K., Paciaroni, M., Wilson, D., Koga, M., Cappellari, M.,... Engelter, S.T. (2021). Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation. Annals of Neurology. https://dx.doi.org/10.1002/ana.26267

MLA:

Polymeris, Alexandros A., et al. "Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation." Annals of Neurology (2021).

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