학술논문
Non-vitamin K oral anticoagulant use in the elderly: a prospective real-world study--data from the REGIstry of patients on non-vitamin K oral Anticoagulants (REGINA)
Document Type
Clinical report
Author
Source
Vascular Health and Risk Management. February 28, 2019, Vol. 15, p19, 6 p.
Subject
Language
English
ISSN
1178-2048
Abstract
Purpose: Numerous studies on thromboembolic prevention for non-valvular atrial fibrillation (NVAF) have shown either equal or better efficacy and safety of non-vitamin K oral anticoagulants (NOACs) compared to warfarin, even for patients aged [greater than or equal to]75 years. Data on elderly patients, in particular, octogenarians, are lacking. Paradoxically, this population is the one with the highest risk of bleeding and stroke with a worse prognosis. This study aims to describe safety and effectiveness of NOACs in an elderly comorbid population. Patients and methods: REGIstry of patients on Non-vitamin K oral Anticoagulants (REGINA) is a prospective observational study enrolling consecutive NVAF patients started on NOACs and followed up to 1 year (at 1, 6, 12 months). The primary endpoint was the incidence rate of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB). The secondary endpoints were the incidence of 1) stroke or systemic embolism, 2) hospitalization, 3) death, and 4) drug-related adverse events. Results: We enrolled 227 patients aged 81.6+6.1 years (range 67-95 years; [greater than or equal to]80 years in 59.4%). The median CH[A.sub.2]D[S.sub.2]-VASc was 5 (IQR 4-5) and HAS-BLED was 4 (IQR 3-5). The estimated glomerular filtration rate was 59.27+24.12 mL/min. During follow-up, only 10 MB and 23 CRNMB occurred, with a total incidence of 4.4% (95% CI: 1.7%-7.17%) and 5.7% (95% CI: 2.68%-8.72%), respectively. There were 2 cerebral ischemic events, with a total incidence of 0.88% (95% CI: 0.84%-0.92%), 23 NOAC-related hospitalizations, no NOAC-related deaths, and 4 minor drug-related adverse effects. Conclusion: In a population of aged and clinically complex patients, mainly octogenarians, NOACs were safe and effective. Keywords: NVAF, anticoagulation, elderly, octogenarians, cardiac rehabilitation, NOAC
Introduction Non-vitamin K oral anticoagulant (NOAC) therapy has been increasingly used for stroke prevention in non-valvular atrial fibrillation (NVAF) (1) due to its proven effectiveness and safety. Real-world data have [...]
Introduction Non-vitamin K oral anticoagulant (NOAC) therapy has been increasingly used for stroke prevention in non-valvular atrial fibrillation (NVAF) (1) due to its proven effectiveness and safety. Real-world data have [...]