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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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dc.contributor.authorCaldeira, Daniel
dc.contributor.authorNunes-Ferreira, Afonso
dc.contributor.authorRodrigues, Raquel
dc.contributor.authorVicente, Eunice
dc.contributor.authorPinto, Fausto J.
dc.contributor.authorFerreira, Joaquim J.
dc.date.accessioned2019-07-19T10:34:29Z
dc.date.available2019-07-19T10:34:29Z
dc.date.issued2019
dc.description© 2019 Elsevier B.V. All rights reserved.pt_PT
dc.description.abstractBackground: 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.pt_PT
dc.description.sponsorshipDaniel Caldeira received a scholarship by Fundação para a Ciência eTecnologia (FCT) [SFRH/SINTD/96409/2013].pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationArchives of Gerontology and Geriatrics 81 (2019) 209–214pt_PT
dc.identifier.doi10.1016/j.archger.2018.12.013pt_PT
dc.identifier.issn0167-4943
dc.identifier.urihttp://hdl.handle.net/10451/39187
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relationSafety of oral antithrombotic drugs in Portugal: frequency and resource consumption of iatrogenic bleeding in Portugal.
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/archives-of-gerontology-and-geriatricspt_PT
dc.subjectApixabanpt_PT
dc.subjectDabigatranpt_PT
dc.subjectEdoxabanpt_PT
dc.subjectRivaroxabanpt_PT
dc.subjectElderlypt_PT
dc.subjectDOACpt_PT
dc.titleNon-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation : a systematic review with meta-analysis and trial sequential analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardNumberSFRH/SINTD/96409/2013
oaire.awardTitleSafety of oral antithrombotic drugs in Portugal: frequency and resource consumption of iatrogenic bleeding in Portugal.
oaire.awardURIinfo:eu-repo/grantAgreement/FCT//SFRH%2FSINTD%2F96409%2F2013/PT
oaire.citation.endPage214pt_PT
oaire.citation.startPage209pt_PT
oaire.citation.titleArchives of Gerontology and Geriatricspt_PT
oaire.citation.volume81pt_PT
person.familyNameCaldeira
person.familyNameNunes-Ferreira
person.familyNameRodrigues
person.familyNamePinto
person.familyNameFerreira
person.givenNameDaniel
person.givenNameAfonso
person.givenNameRaquel
person.givenNameFausto J.
person.givenNameJoaquim J
person.identifier1308889
person.identifier1624753
person.identifier.ciencia-idAA19-EC35-8D01
person.identifier.ciencia-id0419-C014-BA22
person.identifier.ciencia-idC311-AEDD-6DBB
person.identifier.ciencia-id7D15-5CD6-6159
person.identifier.orcid0000-0002-2520-5673
person.identifier.orcid0000-0002-2836-9497
person.identifier.orcid0000-0002-7557-1815
person.identifier.orcid0000-0002-8034-4529
person.identifier.orcid0000-0003-3950-5113
person.identifier.ridG-9363-2015
person.identifier.scopus-author-id36623384200
person.identifier.scopus-author-id39862203700
person.identifier.scopus-author-id7102740158
person.identifier.scopus-author-id7403252466
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
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