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The Efficacy, Safety and Adherence to Treatment when New Anticoagulants Taking in Over 75 Years Old Patients with Atrial Fibrillation

https://doi.org/10.20996/1819-6446-2020-20-07

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Abstract

Aim. To study the efficacy, safety, and adherence to therapy with new oral anticoagulants in patients older than 75 years with atrial fibrillation.

Material and methods. Patients (n=431) over 75 years old (82.7±3.4 years) with various types of atrial fibrillation/flutter (AF) were included in a nonrandomized observational study of new oral anticoagulants (NOAC) in real clinical practice. A history of cardiac surgery was in 27.6% of patients. All patients had >3 risk factors for ischemic stroke (CHA2DS2-VASс 4.81±0.4 points) and >1 risk factor for bleeding (HAS-BLED 3.01±0.2 points). The duration of the observation study was from 12 to 42 (26.9±4.9) months. Dabigatran was taken in 38.5% (n=166) of patients, rivaroxaban – in 41.3% (n=178), apixaban – in 20.2% (n=87) of patients.

Results. The incidence of new cases of myocardial infarction was 0.8% per year, surgical revascularization – 0.9% per year, cardiovascular death – 0.8% per year. The frequency of ischemic stroke was 1.1% per year, transient ischemic attacks – 0.4% per year, all thromboembolic episodes – 1.77% per year. The incidence of intracranial hemorrhage was 0.2% per year, of minor bleeding – 4.4% per year, of the combined cardiac point (the total frequency of all strokes, major bleeding, myocardial infarction, mortality from cardiovascular causes, revascularization procedures) – 4.2% per year. Significant differences in the frequency of endpoints depending on the drug of NOAC taken by patients were not found. Violations of the regimen and doses were more often observed with twice daily intake (63.9% for dabigatran and 59.8% for apixaban) than with a single dosage regimen per day (45.5% for rivaroxaban). The leading causes of non-adherence to NOAC therapy in patients over 75 years of age included skipping the next scheduled dose (43.6%) and changing the frequency of the drug taking (16.9%). For NOAC with a double dose per day, dabigatran and apixaban, the frequency of administration was violated in 27.7% and 28.7%, respectively, and with a single dose per day, rivaroxaban – in 1.1%.

Conclusion. Therapy with NOAC in patients older than 75 years with AF is effective and safe. There were no statistically significant differences in the incidence of thromboembolic or hemorrhagic events during three NOACs treatment in patients with AF older than 75 years. The incidence of non-adherence was less  

About the Authors

A. N. Turov
Novosibirsk State University, Institute of Medicine and Psychology
Russian Federation

Alex N. Turov – MD, PhD, Professor, Chair of Internal Medicine

Pirogova ul. 1, Novosibirsk, 630090



S. V. Panfilov
National Medical Research Center named after Academician E.N. Meshalkin
Russian Federation

Sergey V. Panfilov – MD, PhD, Cardiologist

Rechkunovskaya ul. 15, Novosibirsk, 630055



О. V. Tschiglinzeva
National Medical Research Center named after Academician E.N. Meshalkin
Russian Federation

Oxana V. Tschiglinzeva – MD, Cardiologist

Rechkunovskaya ul. 15, Novosibirsk, 630055



References

1. Mandalenakis Z., Von Koch L., Eriksson H., et al. The risk of atrial fibrillation in the general male population: a lifetime follow-up of 50-year-old men. Europace. 2015;17(7):1018-22. DOI:10.1093/europace/euv036.

2. Camm A.J., Kirchhof P., Lip G.Y., et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31(19):2369-429. DOI:10.1093/eurheartj/ehq278.

3. Friberg L., Rosenqvist M., Lip G.Y. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33:1500-10. DOI:10.1093/eurheartj/ehr488.

4. Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962. DOI:10.1093/eurheartj/ehw210.

5. Granger C.B., Alexander J.H., McMurray J.J., et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11):981-92. DOI:10.1056/NEJMoa1107039.

6. Connolly S.J., Ezekowitz M.D., Yusuf S., et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. DOI:10.1056/NEJMoa0905561.

7. Patel M.R., Mahaffey K.W., Garg J., et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91. DOI:10.1056/NEJMoa1009638.

8. Heidbuchel H., Verhamme P., Alings M., et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation Europace. 2013;15:625–51.

9. Kirchhof P., Radaideh G., Kim Y.H., et al. Global Prospective Safety Analysis of Rivaroxaban. J Am Coll Cardiol. 2018;72(2):141-153. DOI:10.1016/j.jacc.2018.04.058.

10. Iguchi M., Esato M., Chun Y.H., et al. on behalf of the Fushimi AF Registry investigators. Low ejection fraction is associated with the history of stroke in Japanese patients with atrial fibrillation: from the Fushimi AF registry. Eur Heart J. 2013;34 Issue suppl_1:P1528. DOI:10.1093/eurheartj/eht308.P1528.

11. Lip G.Y.H., Laroche C., Popescu M.I., et al. Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EUROobservational Research Programme – Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot Registry). Eur Heart J. 2014;35:3365-76. DOI:10.1093/eurheartj/ehu374.

12. Patti G., Lucerna M., Pecen L., et al. Thromboembolic risk, bleeding outcomes and effect of different antithrombotic strategies in very elderly patients with atrial fibrillation: A sub-analysis from the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation). Am Heart Assoc. 2017;6(7);pii:e005657. DOI:10.1161/JAHA.117.005657.

13. Eikelboom J.W., Wallentin L., Connolly S.J., et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation. 2011;123(21):2363-72. DOI:10.1161/CIRCULATIONAHA.110.004747.

14. Halperin J.L., Hankey G.J., Wojdyla D.M., et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 2014;130(2):138-46. DOI:10.1161/CIRCULATIONAHA.113.005008.

15. Lauw M.N., Eikelboom J.W., Coppens M., et al. Effects of dabigatran according to age in atrial fibrillation. Heart. 2017;103(13):1015-23. DOI:10.1136/heartjnl-2016-310358.

16. Halvorsen S., Atar D., Yang H., et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J. 2014;35(28):864-72. DOI:10.1093/eurheartj/ehu046.

17. Sarich T.C., Seltzer J.H., Berkowitz S.D., et al. Novel oral anticoagulants and reversal agents: Considerations for clinical development. Am Heart J. 2015;169(6):751-7. DOI:10.1016/j.ahj.2015.03.010.

18. Gallagher A.M., Rietbrock S., Plumb J., van Staa T.P. Initiation and persistence of warfarin or aspirin in patients with chronic atrial fibrillation in general practice: do the appropriate patients receive stroke prophylaxis? J Thromb Haemost. 2008;6(9):1500-6. DOI:10.1111/j.1538-7836.2008.03059.x.

19. Demenko T.N., Chumakova G.A., Chugunova Y.V. Features of cognitive function in patients with atrial fibrillation. Annals of Arrhythmology. 2015;12(4):215-24 (In Russ.)

20. Kachkovsky M.A. Adherence to drug therapy for patients with atrial fibrillation. Bulletin of the RUDN University. 2010:(4):229-33 (In Russ.)

21. Camm A.J., Amarenco P., Haas S., et al. XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation. Eur Heart J. 2016;37(14):1145-53. DOI:10.1093/eurheartj/ehv466.

22. Coleman C.I., Weeda E.R., Nguyen E., et al. Effectiveness and safety of rivaroxaban vs. warfarin in patients 80+ years of age with non-valvular atrial fibrillation. Eur Heart J Qual Care Clin Outcomes. 2018;4(4):328-9. DOI:10.1093/ehjqcco/qcx044.

23. Moore N., Fauchier L., Dureau-Pournin C., et al. Two-Year Benefit-Risk of Standard and Reduced Doses of Rivaroxaban versus Vitamin-K Antagonists in Non-Valvular Atrial Fibrillation: A Cohort Study in the French Nationwide Claims Database. Abstract 14523. Circulation. 2018;138:A14523.


For citation:


Turov A.N., Panfilov S.V., Tschiglinzeva О.V. The Efficacy, Safety and Adherence to Treatment when New Anticoagulants Taking in Over 75 Years Old Patients with Atrial Fibrillation. Rational Pharmacotherapy in Cardiology. 2020;16(1):10-18. (In Russ.) https://doi.org/10.20996/1819-6446-2020-20-07

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