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Safety outcomes of direct oral anticoagulants in older adults with atrial fibrillation: a systematic review and meta-analysis of (subgroup analyses from) randomized controlled trials
AbstractBalancing stroke prevention and risk of bleeding in patients with atrial fibrillation (AF) is challenging. Direct oral anticoagulants (DOACs) are by now considered standard of care for treating patients with AF in international guidelines. Our objective was to assess the safety of long-term intake of DOACs in older adults with AF. We included RCTs in elderly ( ≥ 65 years) patients with AF. A systematic search in MEDLINE and EMBASE was performed on 19 April 2022. For determination of risk of bias, the RoB 2 tool was applied. We pooled outcomes using random-effects meta-analyses. The quality of evidence was as...
Source: AGE - June 1, 2023 Category: Geriatrics Source Type: research

Direct Oral Anticoagulants and Non-valvular Atrial Fibrillation: Compliance with Dose Level Guidelines in Patients Aged 80  Years and Over
ConclusionsAmong patients with non-valvular atrial fibrillation aged 80 years and over, about 40% of DOAC prescriptions feature inappropriate dose levels. It might be possible to reduce inappropriate dosing by raising awareness among hospital-based and private-practice prescribers, providing prescription support tools for DOACs, and performing medication reconciliations and reviews at hospital and in private practice.
Source: Drugs and Aging - September 6, 2021 Category: Geriatrics Source Type: research

Reasons for discontinuing oral anticoagulation therapy for atrial fibrillation: a systematic review
ConclusionThe available evidence is derived from heterogeneous studies with few relevant data for the newer direct oral anticoagulants. Reasons underpinning decision-making to discontinue OAC from the perspective of patients, family carers and clinicians is poorly understood.
Source: Age and Ageing - March 10, 2021 Category: Geriatrics Source Type: research

The Risk of Falling and Consequences of Falling in Patients with Atrial Fibrillation Receiving Different Types of Anticoagulant
ConclusionOlder patients who had comorbidities and were taking amiodarone, diuretics, or short- or medium-acting benzodiazepines had the highest risk of falls. The type and quality of anticoagulation did not seem to affect the risk of falling but did significantly affect survival after the first fall.
Source: Drugs and Aging - March 2, 2021 Category: Geriatrics Source Type: research

306 The Changing Face of Stroke in the DOAC Era
ConclusionThe majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

122 Are We Effective Prescribers? A Retrospective Audit of DOAC Prescribing Post Embolic Stroke for Non Valvular Atrial Fibrillation
ConclusionA significant number of patients prescribed DOAC in hospital were not appropriately anticoagulated (21%), a majority of which were under-dosed. The patients who were under-dosed were older and more likely to be on 5 or more medications.
Source: Age and Ageing - September 16, 2019 Category: Geriatrics Source Type: research

Reduced Dose Direct Oral Anticoagulants in Older Adults with Atrial Fibrillation
AbstractPurpose of ReviewDoses of direct oral anticoagulants (DOACs) are often reduced in older adults based on age, renal function, and bleeding risk. This review assesses recent evidence for safety and efficacy of reduced dose DOAC regimens in older adults.Recent FindingsDabigatran 110  mg twice daily shows similar efficacy and similar or lower bleeding risk compared to 150 mg twice daily in several studies. Dabigatran 110 mg is approved outside the USA and can be considered in ages>  75–80, or in patients with a propensity for higher dabigatran blood levels. Rivaroxaban 15 mg, apixaban 2.5 mg, and edoxaban 3...
Source: Current Geriatrics Reports - January 31, 2019 Category: Geriatrics Source Type: research

Dabigatran Versus Rivaroxaban for Secondary Stroke Prevention in Patients with Atrial Fibrillation Rehabilitated in Skilled Nursing Facilities
ConclusionsIn older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage.
Source: Drugs and Aging - November 13, 2018 Category: Geriatrics Source Type: research

Introduction of Non-Vitamin K Antagonist Anticoagulants Strongly Increased the Rate of Anticoagulation in Hospitalized Geriatric Patients with Atrial Fibrillation
ConclusionThe introduction of non-vitamin K antagonist oral anticoagulants and an increased awareness of their benefits led to an increased use of anticoagulation from 52.8% (2011) to 87.7% (2015) in geriatric patients with atrial fibrillation and flutter at our institution.
Source: Drugs and Aging - August 1, 2018 Category: Geriatrics Source Type: research

New oral anticoagulants for prophylaxis of stroke : Results of an expert conference on practical use in geriatric patients.
This article highlights the outcome of an expert meeting on the practical use of NOAC in elderly patients. An interdisciplinary group of experts discussed the current situation of stroke prevention in geriatric patients and its practical management in daily clinical practice. The topic was examined through focused impulse presentations and critical analyses as the basis for the expert consensus. The key issues are summarized in this paper. The European Society of Cardiology (ESC) guidelines from 2012 for the management of patients with non-valvular AF recommend NOAC as the preferred treatment and vitamin K antagonists (VKA...
Source: Zeitschrift fur Gerontologie und Geriatrie - February 10, 2016 Category: Geriatrics Authors: Bahrmann P, Harms F, Schambeck CM, Wehling M, Flohr J Tags: Z Gerontol Geriatr Source Type: research

New Oral Anticoagulants in Elderly Adults: Evidence from a Meta‐Analysis of Randomized Trials
ConclusionIn participants of clinical trials aged 75 and older, NOACs did not cause excess bleeding and were associated with equal or greater efficacy than conventional therapy.
Source: Journal of the American Geriatrics Society - May 1, 2014 Category: Geriatrics Authors: Partha Sardar, Saurav Chatterjee, Shobhana Chaudhari, Gregory Y. H. Lip Tags: Clinical Investigations Source Type: research