Oral anticoagulant use and clinical outcomes in elderly Japanese patients: findings from the SAKURA AF Registry

• Published in: Heart and vessels Vol. 34; no. 12; pp. 2021 - 2030
• Main Authors: Nishida, Toshihiko, Okumura, Yasuo, Yokoyama, Katsuaki, Matsumoto, Naoya, Tachibana, Eizo, Kuronuma, Keiichiro, Oiwa, Koji, Matsumoto, Michiaki, Kojima, Toshiaki, Hanada, Shoji, Nomoto, Kazumiki, Sonoda, Kazumasa, Arima, Ken, Kogawa, Rikitake, Takahashi, Fumiyuki, Kotani, Tomobumi, Ohkubo, Kimie, Fukushima, Seiji, Itou, Satoru, Kondo, Kunio, Chiku, Masaaki, Ohno, Yasumi, Onikura, Motoyuki, Hirayama, Atsushi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-12-2019; Springer Nature B.V
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - administration & dosage; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Biomedical Engineering and Bioengineering; Bleeding; Cardiac Surgery; Cardiology; Clinical outcomes; Dose-Response Relationship, Drug; Embolism; Factor Xa Inhibitors - administration & dosage; Female; Fibrillation; Follow-Up Studies; Geriatrics; Humans; Incidence; Japan - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Older people; Original Article; Prevention; Registries; Retrospective Studies; Risk Factors; Stroke; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Survival Rate - trends; Time Factors; Treatment Outcome; Vascular Surgery; Warfarin; Warfarin - administration & dosage; Japan; Warfarin; Aged; Direct oral anticoagulant; Atrial fibrillation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-019-01446-6

Direct-acting oral anticoagulants (DOACs) are widely used in aged Japanese patients with atrial fibrillation (AF), but outcome data for such patients are limited. We compared outcomes between 1895 (58.5%) patients aged < 75 years (non-elderly), 1078 (33.3%) 75–84 years (elderly) and 264 (8.2%) ≥ 85 years (very elderly) enrolled in a prospective multicenter registry. Kaplan–Meier analysis (median follow-up: 39.3 months) revealed a significantly high incidence of stroke/systemic embolism (SE) among the very elderly relative to that among the non-elderly or elderly (3.2 vs. 1.2 and 1.5 events per 100 patient-years,
p
 < 0.001). Major bleeding in the non-elderly group was significantly infrequent relative to that among the elderly or very elderly group (1.1 vs. 1.6 vs. 1.8 events,
p
 = 0.033). After multivariate adjustment, the stroke/SE incidence was comparable between DOAC and warfarin users, regardless of age, but major bleeding decreased significantly among very elderly DOAC users (adjusted HR 0.220, 95% CI 0.042–0.920). The greater increasing incidence of stroke/SE than major bleeding as patients age suggests that stroke prevention should outweigh the bleeding risk when anticoagulants are being considered for aged patients. Our data indicated that DOACs can be a therapeutic option for stroke prevention in very elderly patients.