title: [The use of the new direct oral anticoagulants among older subjects: The limits of the evidence-based medicine?].
abstract: The growing use of direct oral anticoagulants, in particular among older subjects, raises questions about the limits of the evidence-based medicine. The phase III studies that have validated the efficacy and the safety profile of these molecules (dabigatran, rivaroxaban, apixaban, edoxaban) in their both indications, the venous thromboembolic disease and the non-valvular atrial fibrillation raise concerns in four major fields: the financial support of pharmaceutical companies, the links of interest for many authors with the industry, the study design (exclusively non-inferiority studies), and the poor representativeness of the older subjects included. All these points are discussed, using data of sub-groups studies, post-marketing studies and recent meta-analysis. The lack of data for the very old subjects, with frailty or comorbidities, remains the main concern from these phase III studies.
authors.affiliation: Pôle de gériatrie, hôpital de la Robertsau, hôpitaux universitaires de Strasbourg, pavillon Schutzenberger, 83, rue Himmerich, 67091 Strasbourg cedex, France; Équipe d'accueil EA3072 « mitochondrie, stress oxydant et protection musculaire », Fédération de médecine translationnelle (FMTS), institut de physiologie, faculté de médecine, université de Strasbourg, 67000 Strasbourg, France. Electronic address: thomas.vogel@chru-strasbourg.fr.
authors.forename: T
authors.initials: T
authors.lastname: Vogel
authors.affiliation: Centre de médecine préventive Nescens, clinique de Genolier, 1272 Genolier, Suisse; Translational Medicine Research Group, Cranfield Health, Cranfield University, MK043 AL Cranfield, Royaume-Uni.
authors.forename: P-O
authors.initials: PO
authors.lastname: Lang
authors.affiliation: Pôle de gériatrie, hôpital de la Robertsau, hôpitaux universitaires de Strasbourg, pavillon Schutzenberger, 83, rue Himmerich, 67091 Strasbourg cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Kaltenbach
authors.affiliation: Pôle de gériatrie, hôpital de la Robertsau, hôpitaux universitaires de Strasbourg, pavillon Schutzenberger, 83, rue Himmerich, 67091 Strasbourg cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Karcher
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D003627:Data Interpretation, Statistical; D019317:Evidence-Based Medicine; D006801:Humans
chemical_list: D000925:Anticoagulants
keywords: Anticoagulants oraux directs; Elderly; Evidence-based medicine; Médecine basée sur les preuves; New oral anticoagulants; Sujets âgés