| Autor: |
Hayes KN; Department of Health Services, Policy, and Practice Brown University School of Public Health Providence RI.; Graduate Department of Pharmaceutical Sciences University of Toronto Leslie Dan Faculty of Pharmacy Toronto ON Canada., Zhang T; Department of Health Services, Policy, and Practice Brown University School of Public Health Providence RI., Kim DH; Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife and Harvard Medical School Boston MA.; Division of Gerontology, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA., Daiello LA; Department of Health Services, Policy, and Practice Brown University School of Public Health Providence RI.; Department of Neurology Warren Alpert Medical School of Brown University and Alzheimer's Disease and Memory Disorders Center At Rhode Island Hospital Providence RI., Lee Y; Department of Health Services, Policy, and Practice Brown University School of Public Health Providence RI., Kiel DP; Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife and Harvard Medical School Boston MA., Berry SD; Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife and Harvard Medical School Boston MA., Zullo AR; Department of Health Services, Policy, and Practice Brown University School of Public Health Providence RI.; Department of Epidemiology Brown University School of Public Health Providence RI.; Center of Innovation in Long-Term Services and Supports Providence Veterans Affairs Medical Center Providence RI. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2023 Nov 07; Vol. 12 (21), pp. e029865. Date of Electronic Publication: 2023 Nov 06. |
| DOI: |
10.1161/JAHA.122.029865 |
| Abstrakt: |
Background Dose reduction of direct oral anticoagulant (DOAC) medications is inconsistently applied to older adults with multiple morbidities, potentially due to perceived harms and unknown benefits of standard dosing. Methods and Results Using 2013 to 2017 US Medicare claims linked to Minimum Data Set records, we conducted a retrospective cohort study. We identified DOAC initiators (apixaban, dabigatran, rivaroxaban) aged ≥65 years with nonvalvular atrial fibrillation residing in a nursing home. We estimated inverse-probability of treatment weights for DOAC dose using propensity scores. We examined safety (hospitalization for major bleeding) and effectiveness outcomes (all-cause mortality, thrombosis [myocardial infarction, stroke, systemic embolism, venous thromboembolism]). We estimated hazard ratios (HRs) and 95% CIs using cause-specific hazard-regression models. Of 21 878 DOAC initiators, 48% received reduced dosing. The mean age of residents was 82.0 years, 66% were female, and 31% had moderate/severe cognitive impairment. After estimating inverse-probability of treatment weights, standard dosing was associated with a higher rate of bleeding (HR, 1.18 [95% CI, 1.03-1.37]; 9.4 versus 8.0 events per 100 person-years). Standard-dose therapy was associated with the highest rates of bleeding among those aged >80 years (9.1 versus 6.7 events per 100 person-years) and with a body mass index <30 kg/m 2 (9.4 versus 7.4 events per 100 person-years). There was no association of dosing with mortality (HR, 0.99 [95% CI, 0.96-1.06]) or thrombotic events (HR, 1.16 [95% CI, 0.96-1.41]). Conclusions In this nationwide study of nursing home residents with nonvalvular atrial fibrillation, we found a higher rate of bleeding and little difference in effectiveness of standard versus reduced-dose DOAC treatment. Our results support the use of reduced-dose DOACs for many older adults with multiple morbidities. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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