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Europace. 2019 Oct 22. pii: euz285. doi: 10.1093/europace/euz285. [Epub ahead of print]

Reduced dose of rivaroxaban and dabigatran vs. vitamin K antagonists in very elderly patients with atrial fibrillation in a nationwide cohort study.

Author information

1
Service de Cardiologie, Centre Hospitalier, Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Centre Hospitalier Universitaire Trousseau, Tours, France.
2
Bordeaux PharmacoEpi, INSERM CIC 1401 Université de Bordeaux, CHU de Bordeaux, Bordeaux, France.
3
IHU LIRYC, Univ. Bordeaux, INSERM 1045, Bordeaux, France.
4
Service de Cardiologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
5
INSERM U1167, Institut Pasteur, Lille, France.
6
INSERM U1219, Université de Bordeaux, Bordeaux, France.

Abstract

AIMS:

The real-life benefits and risks of the non-vitamin K antagonist oral anticoagulants for stroke prevention in very elderly patients with atrial fibrillation (AF) are still debated.

METHODS AND RESULTS:

Cohorts of new users of rivaroxaban 15 mg, dabigatran 110 mg, or vitamin K antagonists (VKA) for AF ≥85 years old in 2013 or 2014 were identified in the nationwide French claims database and followed-up for 1 year. Cohorts were compared after 1:1 matching using high-dimensional propensity score. Compared to VKA use and considering 1-year cumulative incidences, risk of stroke, and systemic embolism was not different with rivaroxaban use [hazard ratio 1.14, 95% confidence interval (CI): 0.93-1.40] and lower with dabigatran use (0.77, 95% CI: 0.60-0.99), risk of major bleeding was not different with rivaroxaban use (0.91, 95% CI: 0.74-1.11) and with dabigatran use (0.81, 95% CI: 0.64-1.03), risk of all-cause death was borderline to significance lower with rivaroxaban use (0.91, 95% CI: 0.83-1.00), and lower with dabigatran use (0.87, 95% CI: 0.78-0.97). The risk for a composite of all events above was not different with rivaroxaban use (0.96, 95% CI: 0.88-1.04) and lower with dabigatran use (0.87, 95% CI: 0.79-0.96) as compared with VKA use. The risk for the composite of all events was not different with rivaroxaban use as compared with dabigatran use (1.09, 95% CI: 0.97-1.23).

CONCLUSION:

This study shows for the first time in more than 25 000 new real-life anticoagulant users for AF aged ≥85 years a neutral overall benefit-risk of rivaroxaban 15 mg vs. VKA and a favourable overall benefit-risk of dabigatran 110 mg vs. VKA on relevant clinical events.

STUDY REGISTRATION:

European Medicines Agency EUPAS14567 (www.encepp.eu) and Clinicaltrials.gov id NCT02864758.

KEYWORDS:

Atrial fibrillation; Bleeding; Dabigatran; Dose; Rivaroxaban; Stroke

PMID:
31638652
DOI:
10.1093/europace/euz285

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