Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation.

Autor:	Polymeris AA; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.; Neurology and Neurorehabilitation, University Hospital for Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland., Macha K; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany., Paciaroni M; Neurology - Stroke Unit, IRCCS MultiMedica, Milan, Italy., Wilson D; Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.; New Zealand Brain Research Institute, Christchurch, New Zealand., Koga M; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Cappellari M; Stroke Unit - Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Schaedelin S; Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland., Zietz A; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland., Peters N; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.; Neurology and Neurorehabilitation, University Hospital for Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.; Stroke Center, Klinik Hirslanden, Zurich, Switzerland., Seiffge DJ; Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.; Department of Neurology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland., Haupenthal D; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany., Gassmann L; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany., De Marchis GM; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland., Wang R; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany., Gensicke H; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.; Neurology and Neurorehabilitation, University Hospital for Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland., Stoll S; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany., Thilemann S; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland., Avramiotis NS; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland., Bonetti B; Stroke Unit - Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Tsivgoulis G; Second Department of Neurology, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece.; Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA., Ambler G; Department of Statistical Science, University College London, London, UK., Alberti A; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Yoshimura S; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Brown MM; Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK., Shiozawa M; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Lip GYH; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, UK.; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Venti M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Acciarresi M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Tanaka K; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Mosconi MG; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Takagi M; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Jäger RH; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK., Muir K; Institute of Neuroscience & Psychology, University of Glasgow and Queen Elizabeth University Hospital, Glasgow, UK., Inoue M; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Schwab S; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany., Bonati LH; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland., Lyrer PA; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland., Toyoda K; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Caso V; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy., Werring DJ; Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK., Kallmünzer B; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany., Engelter ST; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.; Neurology and Neurorehabilitation, University Hospital for Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.
Jazyk:	angličtina
Zdroj:	Annals of neurology [Ann Neurol] 2022 Jan; Vol. 91 (1), pp. 78-88. Date of Electronic Publication: 2021 Nov 29.
DOI:	10.1002/ana.26267
Abstrakt:	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. (© 2021 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)
Databáze:	MEDLINE
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