Dabigatran use in elderly patients with atrial fibrillation.
In elderly patients (≥ 75 years), evidence of dabigatran efficacy is lacking and increased vigilance is warranted. We aimed to assess dabigatran effectiveness and safety in elderly patients in real-world practice. We conducted a population-based study using administrative databases, in Quebec (1999-2013). Dabigatran users (110/150 mg) were compared with matched warfarin users with regard to stroke and bleeding events. Age was categorised into < 75 or ≥ 75 years. Propensity score adjusted models were used. The cohort consisted of 15,918 dabigatran users and 47,192 matched warfarin users, with 67.3% being elderly patients. The elderly predominantly used the lower dose (80.1%) while younger patients mainly used the higher dose (80.0%). In multivariable analyses adjusted for propensity score, the risk of stroke in elderly patients using dabigatran, was no different than the risk in warfarin users (HR 1.05, 95% CI: 0.93, 1.19) regardless of dabigatran dose. However, dabigatran was associated with lower rates of intracranial haemorrhage (HR 0.60, 95% CI: 0.47-0.76) and higher rates of gastrointestinal bleeding (HR 1.30 95% CI: 1.14-1.50) when compared to warfarin. Based on real-life experience, dabigatran can offer an alternative to warfarin in elderly patients, with fewer intracranial bleeding events. However, caution is warranted for gastrointestinal bleeding.
Meytal
M
Avgil-Tsadok
Cynthia A
CA
Jackevicius
Vidal
V
Essebag
Mark J
MJ
Eisenberg
Elham
E
Rahme
Hassan
H
Behlouli
Louise Pilote, MD, MPH, PhD, McGill University Health Centre, 687 Pine Ave West, V Building, Montreal, Quebec, H3A 1A1 Canada, Tel.: +1 514 934 1934 ext. 44722, Fax: +1 514 934 8293, E-mail: louise.pilote@mcgill.ca.
Louise
L
Pilote
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001777:Blood Coagulation / Q000187:drug effects*; D000069604:Dabigatran / Q000008:administration & dosage* / Q000009:adverse effects; D016208:Databases, Factual; D017723:Drug Utilization Review; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011792:Quebec; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
D000925:Anticoagulants; D000991:Antithrombins; D014859:Warfarin; D000069604:Dabigatran
Anticoagulants; atrial fibrillation; bleeding; elderly; stroke