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New Oral Anticoagulants in Elderly Adults: Evidence from a Meta‐Analysis of Randomized Trials
Author(s) -
Sardar Partha,
Chatterjee Saurav,
Chaudhari Shobhana,
Lip Gregory Y. H.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12799
Subject(s) - medicine , apixaban , dabigatran , rivaroxaban , randomized controlled trial , population , odds ratio , cochrane library , stroke (engine) , intensive care medicine , warfarin , atrial fibrillation , engineering , mechanical engineering , environmental health
Objectives To evaluate the efficacy and safety of new oral anticoagulants ( NOAC s) in elderly adults. Design Meta‐analyses of randomized clinical trials ( RCT s). Setting PubMed, C ochrane L ibrary, EMBASE , W eb of S cience, and CINAHL databases were searched from J anuary 1, 2001, through M arch 30, 2013. Participants Elderly population (≥75) in RCT s comparing NOAC s (rivaroxaban, apixaban, and dabigatran) with conventional therapy. Measurements Two authors reviewed the trials, and odds ratios ( OR s) were calculated using a random effects model. Results Ten RCT s included 25,031 elderly participants. Risk of major or clinically relevant bleeding was not significantly different between NOAC s and conventional therapy in elderly adults ( OR = 1.02, 95% confidence interval = 0.73–1.43). Similar results were observed when comparing NOAC s and pharmacologically active agents. In atrial fibrillation ( AF ) trials, NOAC s were more effective than conventional therapy in prevention of stroke or systemic embolism in an elderly population with AF . In non‐ AF trials, NOAC s also had a significantly lower risk of venous thromboembolism ( VTE ) or VTE ‐related death than conventional therapy in elderly adults. Analysis for individual NOAC s showed that the NOAC was noninferior or more effective than conventional therapy for efficacy and safety outcomes. Conclusion In participants of clinical trials aged 75 and older, NOAC s did not cause excess bleeding and were associated with equal or greater efficacy than conventional therapy.