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Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies

1
Department of Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK
2
Pharmacy Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK
3
Research Institute for the Care of Older People (RICE), Bath BA1 3NG, UK
4
Institute of Clinical Neurosciences, University of Bristol, Bristol BS8 1TH, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(4), 554; https://doi.org/10.3390/jcm8040554
Received: 7 March 2019 / Revised: 18 April 2019 / Accepted: 18 April 2019 / Published: 24 April 2019
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Abstract

Older people, are underrepresented in randomised controlled trials of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation (AF). The aim of this study was to combine data from observational studies to provide evidence for the treatment of people aged ≥75 years. Medline, Embase, Scopus and Web of Science were searched. The primary effectiveness outcome was ischaemic stroke. Safety outcomes were major bleeding, intracranial haemorrhage, gastrointestinal bleeding, myocardial infarction, and mortality. Twenty-two studies were eligible for inclusion. Two studies related specifically to people ≥75 years but were excluded from meta-analysis due to low quality; all data in the meta-analyses were from subgroups. The pooled risk estimate of ischaemic stroke was slightly lower for DOACs. There was no significant difference in major bleeding, mortality, or myocardial infarction. Risk of intracranial haemorrhage was 44% lower with DOACs, but risk of GI bleeding was 46% higher. Our results suggest that DOACs may be preferable for the majority of older patients with AF, provided they are not at significant risk of a GI bleed. However, these results are based entirely on data from subgroup analyses so should be interpreted cautiously. There is a need for adequately powered research in this patient group. View Full-Text
Keywords: anticoagulants; atrial fibrillation; stroke; hemorrhage; aged anticoagulants; atrial fibrillation; stroke; hemorrhage; aged
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Mitchell, A.; Watson, M.C.; Welsh, T.; McGrogan, A. Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies. J. Clin. Med. 2019, 8, 554.

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