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Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation : a systematic review with meta-analysis and trial sequential analysis
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Orientador(es)
Resumo(s)
Background: Elderly population is known to be associated with polymedication, comorbidities and altered drugpharmacokinetics. However, the most adequate oral anticoagulant, attending to its relative efficacy and safety,remains unclear.Methods: We searched for phase III randomized controlled trials (MEDLINE, Cochrane Library, SciELO col-lection and Web of Science) comparing novel non-vitamin K antagonist oral anticoagulants (NOACs) withVitamin K antagonists (VKA) in the elderly population (≥75 years-old) in atrialfibrillation (AF). Risk ratios (RR)were calculated using a random effects model. Trial sequential analysis (TSA) was performed in statisticallysignificant results to evaluate whether cumulative sample size was powered.Results: Four trials rendered data about elderly (≥75 years-old) and younger patients (< 75 years-old) withAF. NOACs demonstrated a 30% significant risk reduction (RR 0.70, 95% CI: 0.61 to 0.80) in elderly patientscompared to VKA, without heterogeneity across studies (I2= 0%). The TSA showed that cumulative evidence ofthis subgroup exceeded the minimum information size required for the risk reduction. In younger patients, VKAand NOACs shared a similar risk of stroke and systemic embolism (RR 0.97, 95% CI: 0.79 to 1.18). Regardingmajor bleeding risk in the elderly, the overall comparative risk of NOACs was not different from VKA (RR 0.91,95% CI: 0.72 to 1.16; I2= 86%).Conclusions: NOACs reduce significantly the risk of stroke and systemic embolism in elderly patients withoutincreasing major bleeding events. The dimension of stroke risk reduction was significantly higher in the elderlythan in younger adults.
Descrição
© 2019 Elsevier B.V. All rights reserved.
Palavras-chave
Apixaban Dabigatran Edoxaban Rivaroxaban Elderly DOAC
Contexto Educativo
Citação
Archives of Gerontology and Geriatrics 81 (2019) 209–214
Editora
Elsevier