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

Επιστημονική δημοσίευση - Άρθρο Περιοδικού uoadl:2996944 101 Αναγνώσεις

Μονάδα:
Ερευνητικό υλικό ΕΚΠΑ
Τίτλος:
Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Έτος δημοσίευσης:
2022
Συγγραφείς:
Polymeris, A.A.
Macha, K.
Paciaroni, M.
Wilson, D.
Koga, M.
Cappellari, M.
Schaedelin, S.
Zietz, A.
Peters, N.
Seiffge, D.J.
Haupenthal, D.
Gassmann, L.
De Marchis, G.M.
Wang, R.
Gensicke, H.
Stoll, S.
Thilemann, S.
Avramiotis, N.S.
Bonetti, B.
Tsivgoulis, G.
Ambler, G.
Alberti, A.
Yoshimura, S.
Brown, M.M.
Shiozawa, M.
Lip, G.Y.H.
Venti, M.
Acciarresi, M.
Tanaka, K.
Mosconi, M.G.
Takagi, M.
Jäger, R.H.
Muir, K.
Inoue, M.
Schwab, S.
Bonati, L.H.
Lyrer, P.A.
Toyoda, K.
Caso, V.
Werring, D.J.
Kallmünzer, B.
Engelter, S.T.
Engelter, S.T.
Lyrer, P.A.
Bonati, L.H.
Seiffge, D.J.
Traenka, C.
Polymeris, A.A.
Zietz, A.
Peters, N.
De Marchis, G.M.
Thilemann, S.
Avramiotis, N.S.
Gensicke, H.
Hert, L.
Wagner, B.
Schaub, F.
Meya, L.
Fladt, J.
Dittrich, T.
Fisch, U.
Macha, K.
Haupenthal, D.
Gassmann, L.
Wang, R.
Stoll, S.
Schwab, S.
Volbers, B.
Siedler, G.
Kallmünzer, B.
Cappellari, M.
Bonetti, B.
Bovi, P.
Tomelleri, G.
Micheletti, N.
Zivelonghi, C.
Emiliani, A.
Parry-Jones, A.
Patterson, C.
Price, C.
Elmarimi, A.
Parry, A.
Nallasivam, A.
Nor, A.M.
Esis, B.
Bruce, D.
Bhaskaran, B.
Roffe, C.
Cullen, C.
Holmes, C.
Cohen, D.
Hargroves, D.
Mangion, D.
Chadha, D.
Vahidassr, D.
Manawadu, D.
Giallombardo, E.
Warburton, E.
Flossman, E.
Gunathilagan, G.
Proschel, H.
Emsley, H.
Anwar, I.
Burger, I.
Okwera, J.
Putterill, J.
O’Connell, J.
Bamford, J.
Corrigan, J.
Scott, J.
Birns, J.
Kee, K.
Saastamoinen, K.
Pasco, K.
Dani, K.
Sekaran, L.
Choy, L.
Iveson, L.
Mamun, M.
Sajid, M.
Cooper, M.
Burn, M.
Smith, M.
Power, M.
Davis, M.
Smyth, N.
Veltkamp, R.
Sharma, P.
Guyler, P.
O’Mahony, P.
Wilkinson, P.
Datta, P.
Aghoram, P.
Marsh, R.
Luder, R.
Meenakishundaram, S.
Subramonian, S.
Leach, S.
Ispoglou, S.
Andole, S.
England, T.
Manoj, A.
Harrington, F.
Rehman, H.
Sword, J.
Staals, J.
Mahawish, K.
Harkness, K.
Shaw, L.
McCormich, M.
Sprigg, N.
Mansoor, S.
Krishnamurthy, V.
Giustozzi, M.
Acciarresi, M.
Agnelli, G.
Becattini, C.
Alberti, A.
D’Amore, C.
Cimini, L.A.
Bandini, F.
Tsivgoulis, G.
Liantinioti, C.
Chondrogianni, M.
Yaghi, S.
Furie, K.L.
Tadi, P.
Zedde, M.
Abdul-Rahim, A.H.
Lees, K.R.
Bovi, P.
Carletti, M.
Rigatelli, A.
Cappellari, M.
Putaala, J.
Tomppo, L.
Tatlisumak, T.
Marcheselli, S.
Pezzini, A.
Poli, L.
Padovani, A.
Vannucchi, V.
Masotti, L.
Sohn, S.-I.
Lorenzini, G.
Tassi, R.
Guideri, F.
Acampa, M.
Martini, G.
Ntaios, G.
Athanasakis, G.
Makaritsis, K.
Karagkiozi, E.
Vadikolias, K.
Mumoli, N.
Galati, F.
Sacco, S.
Tiseo, C.
Corea, F.
Ageno, W.
Bellesini, M.
Colombo, G.
Silvestrelli, G.
Ciccone, A.
Lanari, A.
Scoditti, U.
Denti, L.
Mancuso, M.
Maccarrone, M.
Ulivi, L.
Orlandi, G.
Giannini, N.
Tassinari, T.
De Lodovici, M.L.
Rueckert, C.
Baldi, A.
Toni, D.
Letteri, F.
Pieroni, A.
Giuntini, M.
Lotti, E.M.
Flomin, Y.
Kargiotis, O.
Karapanayiotides, T.
Monaco, S.
Baronello, M.M.
Csiba, L.
Szabó, L.
Chiti, A.
Giorli, E.
Del Sette, M.
Imberti, D.
Zabzuni, D.
Doronin, B.
Volodina, V.
Michel, P.
Vanacker, P.
Barlinn, K.
Pallesen, L.-P.
Barlinn, J.
Deleu, D.
Melikyan, G.
Ibrahim, F.
Akhtar, N.
Gourbali, V.
Todo, K.
Kimura, K.
Shibazaki, K.
Yagita, Y.
Furui, E.
Itabashi, R.
Terasaki, T.
Shiokawa, Y.
Hirano, T.
Suzuki, R.
Kamiyama, K.
Nakagawara, J.
Takizawa, S.
Homma, K.
Okuda, S.
Okada, Y.
Maeda, K.
Kameda, T.
Kario, K.
Nagakane, Y.
Hasegawa, Y.
Akiyama, H.
Shibuya, S.
Mochizuki, H.
Ito, Y.
Nakashima, T.
Matsuoka, H.
Takamatsu, K.
Nishiyama, K.
Tanaka, K.
Endo, K.
Miyagi, T.
Osaki, M.
Kobayashi, J.
Okata, T.
Tanaka, E.
Sakamoto, Y.
Tokunaga, K.
Takizawa, H.
Takasugi, J.
Matsubara, S.
Higashida, K.
Matsuki, T.
Kinoshita, N.
Shiozawa, M.
Ide, T.
Yoshimoto, T.
Ando, D.
Fujita, K.
Kumamoto, M.
Kamimura, T.
Kikuno, M.
Mizoguchi, T.
Sato, T.
NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, RAF, RAF-DOAC, SAMURAI-NVAF
Verona Registry Collaborators
Περιοδικό:
Annals of Neurology
Εκδότης:
John Wiley and Sons Inc
Τόμος:
91
Αριθμός / τεύχος:
1
Σελίδες:
78-88
Λέξεις-κλειδιά:
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
Επίσημο URL (Εκδότης):
DOI:
10.1002/ana.26267
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