Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation

Polymeris, A. A.; Macha, K.; Paciaroni, M.; Wilson, D.; Koga, M.; Cappellari, M.; Schaedelin, S.; Zietz, A.; Peters, N.; Seiffge, D. J.; Haupenthal, D.; Gassmann, L.; De Marchis, G. M.; Wang, R.; Gensicke, H.; Stoll, S.; Thilemann, S.; Avramiotis, N. S.; Bonetti, B.; Tsivgoulis, G.; Ambler, G.; Alberti, A.; Yoshimura, S.; Brown, M. M.; Shiozawa, M.; Lip, G. Y. H.; Venti, M.; Acciarresi, M.; Tanaka, K.; Mosconi, M. G.; Takagi, M.; Jager, R. H.; Muir, K.; Inoue, M.; Schwab, S.; Bonati, L. H.; Lyrer, P. A.; Toyoda, K.; Caso, V.; Werring, D. J.; Kallmunzer, B.; Engelter, S. T.; Engelter, S. T.; Lyrer, P. A.; Bonati, L. H.; Seiffge, D. J.; Traenka, C.; Polymeris, A. A.; Zietz, A.; Peters, N.; De Marchis, G. M.; Thilemann, S.; Avramiotis, N. S.; Gensicke, H.; Hert, L.; Wagner, B.; Schaub, F.; Meya, L.; Fladt, J.; Dittrich, T.; Fisch, U.; Macha, K.; Haupenthal, D.; Gassmann, L.; Wang, R.; Stoll, S.; Schwab, S.; Volbers, B.; Siedler, G.; Kallmunzer, B.; Cappellari, M.; Bonetti, B.; Bovi, P.; Tomelleri, G.; Micheletti, N.; Zivelonghi, C.; Emiliani, A.; Parry-Jones, A.; Patterson, C.; Price, C.; Elmarimi, A.; Parry, A.; Nallasivam, A.; Nor, A. M.; Esis, B.; Bruce, D.; Bhaskaran, B.; Roffe, C.; Cullen, C.; Holmes, C.; Cohen, D.; Hargroves, D.; Mangion, D.; Chadha, D.; Vahidassr, D.; Manawadu, D.; Giallombardo, E.; Warburton, E.; Flossman, E.; Gunathilagan, G.; Proschel, H.; Emsley, H.; Anwar, I.; Burger, I.; Okwera, J.; Putterill, J.; O'Connell, J.; Bamford, J.; Corrigan, J.; Scott, J.; Birns, J.; Kee, K.; Saastamoinen, K.; Pasco, K.; Dani, K.; Sekaran, L.; Choy, L.; Iveson, L.; Mamun, M.; Sajid, M.; Cooper, M.; Burn, M.; Smith, M.; Power, M.; Davis, M.; Smyth, N.; Veltkamp, R.; Sharma, P.; Guyler, P.; O'Mahony, P.; Wilkinson, P.; Datta, P.; Aghoram, P.; Marsh, R.; Luder, R.; Meenakishundaram, S.; Subramonian, S.; Leach, S.; Ispoglou, S.; Andole, S.; England, T.; Manoj, A.; Harrington, F.; Rehman, H.; Sword, J.; Staals, J.; Mahawish, K.; Harkness, K.; Shaw, L.; Mccormich, M.; Sprigg, N.; Mansoor, S.; Krishnamurthy, V.; Giustozzi, M.; Acciarresi, M.; Agnelli, G.; Caso, V.; Becattini, C.; Alberti, A.; Venti, M.; D'Amore, C.; Mosconi, M. G.; Cimini, L. A.; Paciaroni, M.; Bandini, F.; Tsivgoulis, G.; Liantinioti, C.; Chondrogianni, M.; Yaghi, S.; Furie, K. L.; Tadi, P.; Zedde, M.; Abdul-Rahim, A. H.; Lees, K. R.; Bovi, P.; Carletti, M.; Rigatelli, A.; Cappellari, M.; Putaala, J.; Tomppo, L.; Tatlisumak, T.; Marcheselli, S.; Pezzini, A.; Poli, L.; Padovani, A.; Vannucchi, V.; Masotti, L.; Sohn, S. -I.; Lorenzini, G.; Tassi, R.; Guideri, F.; Acampa, M.; Martini, G.; Ntaios, G.; Athanasakis, G.; Makaritsis, K.; Karagkiozi, E.; Vadikolias, K.; Mumoli, N.; Galati, F.; Sacco, S.; Tiseo, C.; Corea, F.; Ageno, W.; Bellesini, M.; Colombo, G.; Silvestrelli, G.; Ciccone, A.; Lanari, A.; Scoditti, U.; Denti, L.; Mancuso, M.; Maccarrone, M.; Ulivi, L.; Orlandi, G.; Giannini, N.; Tassinari, T.; De Lodovici, M. L.; Rueckert, C.; Baldi, A.; Toni, D.; Letteri, F.; Pieroni, A.; Giuntini, M.; Lotti, E. M.; Flomin, Y.; Kargiotis, O.; Karapanayiotides, T.; Monaco, S.; Baronello, M. M.; Csiba, L.; Szabo, L.; Chiti, A.; Giorli, E.; Del Sette, M.; Imberti, D.; Zabzuni, D.; Doronin, B.; Volodina, V.; Michel, P.; Vanacker, P.; Barlinn, K.; Pallesen, L. -P.; Barlinn, J.; Deleu, D.; Melikyan, G.; Ibrahim, F.; Akhtar, N.; Gourbali, V.; Todo, K.; Kimura, K.; Shibazaki, K.; Yagita, Y.; Furui, E.; Itabashi, R.; Terasaki, T.; Shiokawa, Y.; Hirano, T.; Suzuki, R.; Kamiyama, K.; Nakagawara, J.; Takizawa, S.; Homma, K.; Okuda, S.; Okada, Y.; Maeda, K.; Kameda, T.; Kario, K.; Nagakane, Y.; Hasegawa, Y.; Akiyama, H.; Shibuya, S.; Mochizuki, H.; Ito, Y.; Nakashima, T.; Matsuoka, H.; Takamatsu, K.; Nishiyama, K.; Tanaka, K.; Endo, K.; Miyagi, T.; Osaki, M.; Kobayashi, J.; Okata, T.; Tanaka, E.; Sakamoto, Y.; Tokunaga, K.; Takizawa, H.; Takasugi, J.; Matsubara, S.; Higashida, K.; Matsuki, T.; Kinoshita, N.; Shiozawa, M.; Ide, T.; Yoshimoto, T.; Ando, D.; Fujita, K.; Kumamoto, M.; Kamimura, T.; Kikuno, M.; Mizoguchi, T.; Sato, T.

doi:10.1002/ana.26267

Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (<3 months) aged ≥85 versus <85 years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all-cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk. Results: In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged ≥85 years and 3,688 (62%) received a DOAC. During 6,874 patient-years follow-up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged ≥85 (HR≥85y = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR<85y = 0.79, 95%-CI [0.66, 0.95]) in simple (pinteraction = 0.129), adjusted (pinteraction = 0.094) or weighted (pinteraction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1). Interpretation: The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021.

Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation

Polymeris A. A.;Macha K.;Paciaroni M.;Wilson D.;Koga M.;Cappellari M.;Schaedelin S.;Zietz A.;Peters N.;Seiffge D. J.;Haupenthal D.;Gassmann L.;De Marchis G. M.;Wang R.;Gensicke H.;Stoll S.;Thilemann S.;Avramiotis N. S.;Bonetti B.;Tsivgoulis G.;Ambler G.;Alberti A.;Yoshimura S.;Brown M. M.;Shiozawa M.;Lip G. Y. H.;Venti M.;Acciarresi M.;Tanaka K.;Mosconi M. G.;Takagi M.;Jager R. H.;Muir K.;Inoue M.;Schwab S.;Bonati L. H.;Lyrer P. A.;Toyoda K.;Caso V.;Werring D. J.;Kallmunzer B.;Engelter S. T.;Engelter S. T.;Lyrer P. A.;Bonati L. H.;Seiffge D. J.;Traenka C.;Polymeris A. A.;Zietz A.;Peters N.;De Marchis G. M.;Thilemann S.;Avramiotis N. S.;Gensicke H.;Hert L.;Wagner B.;Schaub F.;Meya L.;Fladt J.;Dittrich T.;Fisch U.;Macha K.;Haupenthal D.;Gassmann L.;Wang R.;Stoll S.;Schwab S.;Volbers B.;Siedler G.;Kallmunzer B.;Cappellari M.;Bonetti B.;Bovi P.;Tomelleri G.;Micheletti N.;Zivelonghi C.;Emiliani A.;Parry-Jones A.;Patterson C.;Price C.;Elmarimi A.;Parry A.;Nallasivam A.;Nor A. M.;Esis B.;Bruce D.;Bhaskaran B.;Roffe C.;Cullen C.;Holmes C.;Cohen D.;Hargroves D.;Mangion D.;Chadha D.;Vahidassr D.;Manawadu D.;Giallombardo E.;Warburton E.;Flossman E.;Gunathilagan G.;Proschel H.;Emsley H.;Anwar I.;Burger I.;Okwera J.;Putterill J.;O'Connell J.;Bamford J.;Corrigan J.;Scott J.;Birns J.;Kee K.;Saastamoinen K.;Pasco K.;Dani K.;Sekaran L.;Choy L.;Iveson L.;Mamun M.;Sajid M.;Cooper M.;Burn M.;Smith M.;Power M.;Davis M.;Smyth N.;Veltkamp R.;Sharma P.;Guyler P.;O'Mahony P.;Wilkinson P.;Datta P.;Aghoram P.;Marsh R.;Luder R.;Meenakishundaram S.;Subramonian S.;Leach S.;Ispoglou S.;Andole S.;England T.;Manoj A.;Harrington F.;Rehman H.;Sword J.;Staals J.;Mahawish K.;Harkness K.;Shaw L.;McCormich M.;Sprigg N.;Mansoor S.;Krishnamurthy V.;Giustozzi M.;Acciarresi M.;Agnelli G.;Caso V.;Becattini C.;Alberti A.;Venti M.;D'Amore C.;Mosconi M. G.;Cimini L. A.;Paciaroni M.;Bandini F.;Tsivgoulis G.;Liantinioti C.;Chondrogianni M.;Yaghi S.;Furie K. L.;Tadi P.;Zedde M.;Abdul-Rahim A. H.;Lees K. R.;Bovi P.;Carletti M.;Rigatelli A.;Cappellari M.;Putaala J.;Tomppo L.;Tatlisumak T.;Marcheselli S.;Pezzini A.;Poli L.;Padovani A.;Vannucchi V.;Masotti L.;Sohn S. -I.;Lorenzini G.;Tassi R.;Guideri F.;Acampa M.;Martini G.;Ntaios G.;Athanasakis G.;Makaritsis K.;Karagkiozi E.;Vadikolias K.;Mumoli N.;Galati F.;Sacco S.;Tiseo C.;Corea F.;Ageno W.;Bellesini M.;Colombo G.;Silvestrelli G.;Ciccone A.;Lanari A.;Scoditti U.;Denti L.;Mancuso M.;Maccarrone M.;Ulivi L.;Orlandi G.;Giannini N.;Tassinari T.;De Lodovici M. L.;Rueckert C.;Baldi A.;Toni D.;Letteri F.;Pieroni A.;Giuntini M.;Lotti E. M.;Flomin Y.;Kargiotis O.;Karapanayiotides T.;Monaco S.;Baronello M. M.;Csiba L.;Szabo L.;Chiti A.;Giorli E.;Del Sette M.;Imberti D.;Zabzuni D.;Doronin B.;Volodina V.;Michel P.;Vanacker P.;Barlinn K.;Pallesen L. -P.;Barlinn J.;Deleu D.;Melikyan G.;Ibrahim F.;Akhtar N.;Gourbali V.;Todo K.;Kimura K.;Shibazaki K.;Yagita Y.;Furui E.;Itabashi R.;Terasaki T.;Shiokawa Y.;Hirano T.;Suzuki R.;Kamiyama K.;Nakagawara J.;Takizawa S.;Homma K.;Okuda S.;Okada Y.;Maeda K.;Kameda T.;Kario K.;Nagakane Y.;Hasegawa Y.;Akiyama H.;Shibuya S.;Mochizuki H.;Ito Y.;Nakashima T.;Matsuoka H.;Takamatsu K.;Nishiyama K.;Tanaka K.;Endo K.;Miyagi T.;Osaki M.;Kobayashi J.;Okata T.;Tanaka E.;Sakamoto Y.;Tokunaga K.;Takizawa H.;Takasugi J.;Matsubara S.;Higashida K.;Matsuki T.;Kinoshita N.;Shiozawa M.;Ide T.;Yoshimoto T.;Ando D.;Fujita K.;Kumamoto M.;Kamimura T.;Kikuno M.;Mizoguchi T.;Sato T.

2021-01-01

Abstract

Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (<3 months) aged ≥85 versus <85 years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all-cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk. Results: In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged ≥85 years and 3,688 (62%) received a DOAC. During 6,874 patient-years follow-up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged ≥85 (HR≥85y = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR<85y = 0.79, 95%-CI [0.66, 0.95]) in simple (pinteraction = 0.129), adjusted (pinteraction = 0.094) or weighted (pinteraction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1). Interpretation: The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021.

Scheda breve

Scheda completa

Scheda completa (DC)

	Anno
	
			2021
		
	Rivista
	
			ANNALS OF NEUROLOGY
		
	DOI
	
			https://dx.doi.org/10.1002/ana.26267
		
	Codice PUBMED
	
			34747514
		
	Codice Web of Science
	
			WOS:000723176500001
		
	Codice Scopus
	
			2-s2.0-85120034760
		
	Tutti gli autori
	
			Polymeris, A. A.; Macha, K.; Paciaroni, M.; Wilson, D.; Koga, M.; Cappellari, M.; Schaedelin, S.; Zietz, A.; Peters, N.; Seiffge, D. J.; Haupenthal, D.; Gassmann, L.; De Marchis, G. M.; Wang, R.; Gensicke, H.; Stoll, S.; Thilemann, S.; Avramiotis, N. S.; Bonetti, B.; Tsivgoulis, G.; Ambler, G.; Alberti, A.; Yoshimura, S.; Brown, M. M.; Shiozawa, M.; Lip, G. Y. H.; Venti, M.; Acciarresi, M.; Tanaka, K.; Mosconi, M. G.; Takagi, M.; Jager, R. H.; Muir, K.; Inoue, M.; Schwab, S.; Bonati, L. H.; Lyrer, P. A.; Toyoda, K.; Caso, V.; Werring, D. J.; Kallmunzer, B.; Engelter, S. T.; Engelter, S. T.; Lyrer, P. A.; Bonati, L. H.; Seiffge, D. J.; Traenka, C.; Polymeris, A. A.; Zietz, A.; Peters, N.; De Marchis, G. M.; Thilemann, S.; Avramiotis, N. S.; Gensicke, H.; Hert, L.; Wagner, B.; Schaub, F.; Meya, L.; Fladt, J.; Dittrich, T.; Fisch, U.; Macha, K.; Haupenthal, D.; Gassmann, L.; Wang, R.; Stoll, S.; Schwab, S.; Volbers, B.; Siedler, G.; Kallmunzer, B.; Cappellari, M.; Bonetti, B.; Bovi, P.; Tomelleri, G.; Micheletti, N.; Zivelonghi, C.; Emiliani, A.; Parry-Jones, A.; Patterson, C.; Price, C.; Elmarimi, A.; Parry, A.; Nallasivam, A.; Nor, A. M.; Esis, B.; Bruce, D.; Bhaskaran, B.; Roffe, C.; Cullen, C.; Holmes, C.; Cohen, D.; Hargroves, D.; Mangion, D.; Chadha, D.; Vahidassr, D.; Manawadu, D.; Giallombardo, E.; Warburton, E.; Flossman, E.; Gunathilagan, G.; Proschel, H.; Emsley, H.; Anwar, I.; Burger, I.; Okwera, J.; Putterill, J.; O'Connell, J.; Bamford, J.; Corrigan, J.; Scott, J.; Birns, J.; Kee, K.; Saastamoinen, K.; Pasco, K.; Dani, K.; Sekaran, L.; Choy, L.; Iveson, L.; Mamun, M.; Sajid, M.; Cooper, M.; Burn, M.; Smith, M.; Power, M.; Davis, M.; Smyth, N.; Veltkamp, R.; Sharma, P.; Guyler, P.; O'Mahony, P.; Wilkinson, P.; Datta, P.; Aghoram, P.; Marsh, R.; Luder, R.; Meenakishundaram, S.; Subramonian, S.; Leach, S.; Ispoglou, S.; Andole, S.; England, T.; Manoj, A.; Harrington, F.; Rehman, H.; Sword, J.; Staals, J.; Mahawish, K.; Harkness, K.; Shaw, L.; Mccormich, M.; Sprigg, N.; Mansoor, S.; Krishnamurthy, V.; Giustozzi, M.; Acciarresi, M.; Agnelli, G.; Caso, V.; Becattini, C.; Alberti, A.; Venti, M.; D'Amore, C.; Mosconi, M. G.; Cimini, L. A.; Paciaroni, M.; Bandini, F.; Tsivgoulis, G.; Liantinioti, C.; Chondrogianni, M.; Yaghi, S.; Furie, K. L.; Tadi, P.; Zedde, M.; Abdul-Rahim, A. H.; Lees, K. R.; Bovi, P.; Carletti, M.; Rigatelli, A.; Cappellari, M.; Putaala, J.; Tomppo, L.; Tatlisumak, T.; Marcheselli, S.; Pezzini, A.; Poli, L.; Padovani, A.; Vannucchi, V.; Masotti, L.; Sohn, S. -I.; Lorenzini, G.; Tassi, R.; Guideri, F.; Acampa, M.; Martini, G.; Ntaios, G.; Athanasakis, G.; Makaritsis, K.; Karagkiozi, E.; Vadikolias, K.; Mumoli, N.; Galati, F.; Sacco, S.; Tiseo, C.; Corea, F.; Ageno, W.; Bellesini, M.; Colombo, G.; Silvestrelli, G.; Ciccone, A.; Lanari, A.; Scoditti, U.; Denti, L.; Mancuso, M.; Maccarrone, M.; Ulivi, L.; Orlandi, G.; Giannini, N.; Tassinari, T.; De Lodovici, M. L.; Rueckert, C.; Baldi, A.; Toni, D.; Letteri, F.; Pieroni, A.; Giuntini, M.; Lotti, E. M.; Flomin, Y.; Kargiotis, O.; Karapanayiotides, T.; Monaco, S.; Baronello, M. M.; Csiba, L.; Szabo, L.; Chiti, A.; Giorli, E.; Del Sette, M.; Imberti, D.; Zabzuni, D.; Doronin, B.; Volodina, V.; Michel, P.; Vanacker, P.; Barlinn, K.; Pallesen, L. -P.; Barlinn, J.; Deleu, D.; Melikyan, G.; Ibrahim, F.; Akhtar, N.; Gourbali, V.; Todo, K.; Kimura, K.; Shibazaki, K.; Yagita, Y.; Furui, E.; Itabashi, R.; Terasaki, T.; Shiokawa, Y.; Hirano, T.; Suzuki, R.; Kamiyama, K.; Nakagawara, J.; Takizawa, S.; Homma, K.; Okuda, S.; Okada, Y.; Maeda, K.; Kameda, T.; Kario, K.; Nagakane, Y.; Hasegawa, Y.; Akiyama, H.; Shibuya, S.; Mochizuki, H.; Ito, Y.; Nakashima, T.; Matsuoka, H.; Takamatsu, K.; Nishiyama, K.; Tanaka, K.; Endo, K.; Miyagi, T.; Osaki, M.; Kobayashi, J.; Okata, T.; Tanaka, E.; Sakamoto, Y.; Tokunaga, K.; Takizawa, H.; Takasugi, J.; Matsubara, S.; Higashida, K.; Matsuki, T.; Kinoshita, N.; Shiozawa, M.; Ide, T.; Yoshimoto, T.; Ando, D.; Fujita, K.; Kumamoto, M.; Kamimura, T.; Kikuno, M.; Mizoguchi, T.; Sato, T.
		
	Appare nelle tipologie:
	
			Articolo su Rivista

File in questo prodotto:

Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2132801

Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni

1

9

7

Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation

2021-01-01

Abstract

Scheda breve Scheda completa Scheda completa (DC)

Informazioni

Attenzione

Citazioni

social impact

Conferma cancellazione

Scheda breve

Scheda completa

Scheda completa (DC)