RT Journal Article
SR Electronic
T1 Bleeding risk with rivaroxaban compared with vitamin K antagonists in patients aged 80 years or older with atrial fibrillation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1376
OP 1382
DO 10.1136/heartjnl-2020-317923
VO 107
IS 17
A1 Olivier Hanon
A1 Jean-Sébastien Vidal
A1 George Pisica-Donose
A1 Galdric Orvoën
A1 Jean-Philippe David
A1 Edouard Chaussade
A1 Laure Caillard
A1 Laura W de Jong
A1 Nicolas Boulloche
A1 Ulric Vinsonneau
A1 Stéphane Bouée
A1 Pierre Krolak-Salmon
A1 Laurent Fauchier
A1 Pierre Jouanny
A1 Guillaume Sacco
A1 Fabienne Bellarbre
A1 Joël Belmin
A1 François Puisieux
A1 Matthieu Lilamand
A1 Elena Paillaud
A1 Anne Sophie Boureau
A1 ,
YR 2021
UL http://heart.bmj.com/content/107/17/1376.abstract
AB Objective Direct oral anticoagulants have been evaluated in the general population, but proper evidence for their safe use in the geriatric population is still missing. We compared the bleeding risk of a direct oral anticoagulant (rivaroxaban) and vitamin K antagonists (VKAs) among French geriatric patients with non-valvular atrial fibrillation (AF) aged ≥80 years.Methods We performed a sequential observational prospective cohort study, using data from 33 geriatric centres. The sample comprised 908 patients newly initiated on VKAs between September 2011 and September 2014 and 995 patients newly initiated on rivaroxaban between September 2014 and September 2017. Patients were followed up for up to 12 months. One-year risks of major, intracerebral, gastrointestinal bleedings, ischaemic stroke and all-cause mortality were compared between rivaroxaban-treated and VKA-treated patients with propensity score matching and Cox models.Results Major bleeding risk was significantly lower in rivaroxaban-treated patients (7.4/100 patient-years) compared with VKA-treated patients (14.6/100 patient-years) after multivariate adjustment (HR 0.66; 95% CI 0.43 to 0.99) and in the propensity score–matched sample (HR 0.53; 95% CI 0.33 to 0.85). Intracerebral bleeding occurred less frequently in rivaroxaban-treated patients (1.3/100 patient-years) than in VKA-treated patients (4.0/100 patient-years), adjusted HR 0.59 (95% CI 0.24 to 1.44) and in the propensity score–matched sample HR 0.26 (95% CI 0.09 to 0.80). Major lower bleeding risk was largely driven by lower risk of intracerebral bleeding.Conclusions Our study findings indicate that bleeding risk, largely driven by lower risk of intracerebral bleeding, is lower with rivaroxaban than with VKA in stroke prevention in patients ≥80 years old with non-valvular AF.Data are available on reasonable request. The data underlying this article are subject to an embargo of 24 months from the publication date of the article. Once the embargo expires, the data underlying this article will be shared on reasonable request to the corresponding author.