@article{2996944,
    title = "Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation",
    author = "Polymeris, A.A. and Macha, K. and Paciaroni, M. and Wilson, D. and Koga, M. and Cappellari, M. and Schaedelin, S. and Zietz, A. and Peters, N. and Seiffge, D.J. and Haupenthal, D. and Gassmann, L. and De Marchis, G.M. and Wang, R. and Gensicke, H. and Stoll, S. and Thilemann, S. and Avramiotis, N.S. and Bonetti, B. and Tsivgoulis, G. and Ambler, G. and Alberti, A. and Yoshimura, S. and Brown, M.M. and Shiozawa, M. and Lip, G.Y.H. and Venti, M. and Acciarresi, M. and Tanaka, K. and Mosconi, M.G. and Takagi, M. and Jäger, R.H. and Muir, K. and Inoue, M. and Schwab, S. and Bonati, L.H. and Lyrer, P.A. and Toyoda, K. and Caso, V. and Werring, D.J. and Kallmünzer, B. and Engelter, S.T. and Engelter, S.T. and Lyrer, P.A. and Bonati, L.H. and Seiffge, D.J. and Traenka, C. and Polymeris, A.A. and Zietz, A. and Peters, N. and De Marchis, G.M. and Thilemann, S. and Avramiotis, N.S. and Gensicke, H. and Hert, L. and Wagner, B. and Schaub, F. and Meya, L. and Fladt, J. and Dittrich, T. and Fisch, U. and Macha, K. and Haupenthal, D. and Gassmann, L. and Wang, R. and Stoll, S. and Schwab, S. and Volbers, B. and Siedler, G. and Kallmünzer, B. and Cappellari, M. and Bonetti, B. and Bovi, P. and Tomelleri, G. and Micheletti, N. and Zivelonghi, C. and Emiliani, A. and Parry-Jones, A. and Patterson, C. and Price, C. and Elmarimi, A. and Parry, A. and Nallasivam, A. and Nor, A.M. and Esis, B. and Bruce, D. and Bhaskaran, B. and Roffe, C. and Cullen, C. and Holmes, C. and Cohen, D. and Hargroves, D. and Mangion, D. and Chadha, D. and Vahidassr, D. and Manawadu, D. and Giallombardo, E. and Warburton, E. and Flossman, E. and Gunathilagan, G. and Proschel, H. and Emsley, H. and Anwar, I. and Burger, I. and Okwera, J. and Putterill, J. and O’Connell, J. and Bamford, J. and Corrigan, J. and Scott, J. and Birns, J. and Kee, K. and Saastamoinen, K. and Pasco, K. and Dani, K. and Sekaran, L. and Choy, L. and Iveson, L. and Mamun, M. and Sajid, M. and Cooper, M. and Burn, M. and Smith, M. and Power, M. and Davis, M. and Smyth, N. and Veltkamp, R. and Sharma, P. and Guyler, P. and O’Mahony, P. and Wilkinson, P. and Datta, P. and Aghoram, P. and Marsh, R. and Luder, R. and Meenakishundaram, S. and Subramonian, S. and Leach, S. and Ispoglou, S. and Andole, S. and England, T. and Manoj, A. and Harrington, F. and Rehman, H. and Sword, J. and Staals, J. and Mahawish, K. and Harkness, K. and Shaw, L. and McCormich, M. and Sprigg, N. and Mansoor, S. and Krishnamurthy, V. and Giustozzi, M. and Acciarresi, M. and Agnelli, G. and Becattini, C. and Alberti, A. and D’Amore, C. and Cimini, L.A. and Bandini, F. and Tsivgoulis, G. and Liantinioti, C. and Chondrogianni, M. and Yaghi, S. and Furie, K.L. and Tadi, P. and Zedde, M. and Abdul-Rahim, A.H. and Lees, K.R. and Bovi, P. and Carletti, M. and Rigatelli, A. and Cappellari, M. and Putaala, J. and Tomppo, L. and Tatlisumak, T. and Marcheselli, S. and Pezzini, A. and Poli, L. and Padovani, A. and Vannucchi, V. and Masotti, L. and Sohn, S.-I. and Lorenzini, G. and Tassi, R. and Guideri, F. and Acampa, M. and Martini, G. and Ntaios, G. and Athanasakis, G. and Makaritsis, K. and Karagkiozi, E. and Vadikolias, K. and Mumoli, N. and Galati, F. and Sacco, S. and Tiseo, C. and Corea, F. and Ageno, W. and Bellesini, M. and Colombo, G. and Silvestrelli, G. and Ciccone, A. and Lanari, A. and Scoditti, U. and Denti, L. and Mancuso, M. and Maccarrone, M. and Ulivi, L. and Orlandi, G. and Giannini, N. and Tassinari, T. and De Lodovici, M.L. and Rueckert, C. and Baldi, A. and Toni, D. and Letteri, F. and Pieroni, A. and Giuntini, M. and Lotti, E.M. and Flomin, Y. and Kargiotis, O. and Karapanayiotides, T. and Monaco, S. and Baronello, M.M. and Csiba, L. and Szabó, L. and Chiti, A. and Giorli, E. and Del Sette, M. and Imberti, D. and Zabzuni, D. and Doronin, B. and Volodina, V. and Michel, P. and Vanacker, P. and Barlinn, K. and Pallesen, L.-P. and Barlinn, J. and Deleu, D. and Melikyan, G. and Ibrahim, F. and Akhtar, N. and Gourbali, V. and Todo, K. and Kimura, K. and Shibazaki, K. and Yagita, Y. and Furui, E. and Itabashi, R. and Terasaki, T. and Shiokawa, Y. and Hirano, T. and Suzuki, R. and Kamiyama, K. and Nakagawara, J. and Takizawa, S. and Homma, K. and Okuda, S. and Okada, Y. and Maeda, K. and Kameda, T. and Kario, K. and Nagakane, Y. and Hasegawa, Y. and Akiyama, H. and Shibuya, S. and Mochizuki, H. and Ito, Y. and Nakashima, T. and Matsuoka, H. and Takamatsu, K. and Nishiyama, K. and Tanaka, K. and Endo, K. and Miyagi, T. and Osaki, M. and Kobayashi, J. and Okata, T. and Tanaka, E. and Sakamoto, Y. and Tokunaga, K. and Takizawa, H. and Takasugi, J. and Matsubara, S. and Higashida, K. and Matsuki, T. and Kinoshita, N. and Shiozawa, M. and Ide, T. and Yoshimoto, T. and Ando, D. and Fujita, K. and Kumamoto, M. and Kamimura, T. and Kikuno, M. and Mizoguchi, T. and Sato, T. and NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, RAF, RAF-DOAC, SAMURAI-NVAF and Verona Registry Collaborators",
    journal = "Annals of Neurology",
    year = "2022",
    volume = "91",
    number = "1",
    pages = "78-88",
    publisher = "John Wiley and Sons Inc",
    issn = "0364-5134, 1531-8249",
    doi = "10.1002/ana.26267",
    keywords = "anticoagulant agent;  antivitamin K;  apixaban;  dabigatran;  edoxaban;  phenprocoumon;  rivaroxaban;  warfarin, aged;  all cause mortality;  Article;  atrial fibrillation;  brain hemorrhage;  cause of death;  CHA2DS2-VASc score;  clinical trial (topic);  cohort analysis;  controlled study;  drug efficacy;  drug safety;  female;  follow up;  human;  ischemic stroke;  major clinical study;  male;  National Institutes of Health Stroke Scale;  prospective study;  recurrent disease;  secondary analysis;  stroke patient;  transient ischemic attack;  very elderly",
    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 (pinteraction = 0.129), adjusted (pinteraction = 0.094) or weighted (pinteraction = 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 2022;91:78–88. © 2021 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association."
}