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

Autor:	Anneka Mitchell, Margaret C Watson, Anita McGrogan, Tomas J. Welsh
Jazyk:	angličtina
Rok vydání:	2019
Předmět:	RM medicine.medical_specialty Gastrointestinal bleeding anticoagulants MEDLINE lcsh:Medicine Review 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine atrial fibrillation 030212 general & internal medicine Myocardial infarction Stroke business.industry lcsh:R Atrial fibrillation General Medicine Bleed medicine.disease stroke aged Risk Estimate Observational study hemorrhage business
Zdroj:	Journal of Clinical Medicine, Vol 8, Iss 4, p 554 (2019) Journal of Clinical Medicine Mitchell, A, Watson, M, Welsh, T & McGrogan, A 2019, ' 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 ', Journal of Clinical Medicine, vol. 8, no. 4, pp. 554-575 . https://doi.org/10.3390/jcm8040554
ISSN:	2077-0383
DOI:	10.3390/jcm8040554
Popis:	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.
Databáze:	OpenAIRE
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