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Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation
Author(s) -
Polymeris Alexandros A.,
Macha Kosmas,
Paciaroni Maurizio,
Wilson Duncan,
Koga Masatoshi,
Cappellari Manuel,
Schaedelin Sabine,
Zietz Annaelle,
Peters Nils,
Seiffge David J.,
Haupenthal David,
Gassmann Luise,
De Marchis Gian Marco,
Wang Ruihao,
Gensicke Henrik,
Stoll Svenja,
Thilemann Sebastian,
Avramiotis Nikolaos S.,
Bonetti Bruno,
Tsivgoulis Georgios,
Ambler Gareth,
Alberti Andrea,
Yoshimura Sohei,
Brown Martin M.,
Shiozawa Masayuki,
Lip Gregory Y. H.,
Venti Michele,
Acciarresi Monica,
Tanaka Kanta,
Mosconi Maria Giulia,
Takagi Masahito,
Jäger Rolf H.,
Muir Keith,
Inoue Manabu,
Schwab Stefan,
Bonati Leo H.,
Lyrer Philippe A.,
Toyoda Kazunori,
Caso Valeria,
Werring David J.,
Kallmünzer Bernd,
Engelter Stefan T.
Publication year - 2022
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.26267
Subject(s) - medicine , atrial fibrillation , stroke (engine) , hazard ratio , proportional hazards model , confounding , vitamin k antagonist , cardiology , warfarin , pediatrics , confidence interval , mechanical engineering , engineering
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 (p interaction = 0.129), adjusted (p interaction = 0.094) or weighted (p interaction = 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