Real-world comparison of non-vitamin K antagonist oral anticoagulants and warfarin in Asian octogenarian patients with atrial fibrillation.
BACKGROUND
The efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asian octogenarian atrial fibrillation (AF) patients have not been established in a real-world setting. We aimed to evaluate the efficacy and safety of NOACs and warfarin in Korean octogenarian patients.


METHODS
A total of 293 consecutive patients aged ≥ 80 years with non-valvular AF who had taken either NOACs (148 cases, 50.5%) or warfarin (145 cases, 49.5%) were retrospectively reviewed. The efficacy outcome was the composite of stroke or systemic embolism. The safety outcome was major bleeding.


RESULTS
The follow-up duration was 375 patient-years (172 patient-years with NOACs and 203 patient-years with warfarin). Patients on NOACs were slightly older (P = 0.006) and had slightly higher HAS-BLED scores (P = 0.034). The efficacy of both anticoagulants was high (1.16% for NOACs vs. 2.98% for warfarin per 100 patient-years, P = 0.46). The safety outcome was relatively high in both NOACs and warfarin groups (8.96% vs. 12.46%, P = 0.29). The efficacy and safety outcomes tended to decrease non-significantly in low dose NOACs than in common dose NOACs or warfarin (0.85% vs. 1.84% vs. 2.98% in efficacy outcome, P = 0.69; and 6.97% vs. 13.29% vs. 12.46% in safety outcome, P = 0.34).


CONCLUSIONS
NOACs were highly effective for prevention of stroke or systemic embolism in Asian octogenarian AF patients. However, major bleeding occurred excessively high in both anticoagulant groups. Further study is required on the optimal anticoagulant regimen in octogenarian population.
Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
Chang Hee
CH
Kwon
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Minsu
M
Kim
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jun
J
Kim
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Gi-Byoung
GB
Nam
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Kee-Joon
KJ
Choi
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
You-Ho
YH
Kim
Anticoagulants; Atrial fibrillation; Efficacy; Octogenarian; Safety