Final published version
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation
AU - NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, RAF, RAF-DOAC, SAMURAI-NVAF and Verona Registry Collaborators
AU - Polymeris, Alexandros A.
AU - Macha, Kosmas
AU - Paciaroni, Maurizio
AU - Wilson, Duncan
AU - Koga, Masatoshi
AU - Cappellari, Manuel
AU - Schaedelin, Sabine
AU - Zietz, Annaelle
AU - Peters, Nils
AU - Seiffge, David J.
AU - Haupenthal, David
AU - Gassmann, Luise
AU - De Marchis, Gian Marco
AU - Wang, Ruihao
AU - Gensicke, Henrik
AU - Stoll, Svenja
AU - Thilemann, Sebastian
AU - Avramiotis, Nikolaos S.
AU - Bonetti, Bruno
AU - Tsivgoulis, Georgios
AU - Ambler, Gareth
AU - Alberti, Andrea
AU - Yoshimura, Sohei
AU - Shiozawa, Masayuki
AU - Lip, Gregory Y.H.
AU - Venti, Michele
AU - Acciarresi, Monica
AU - Tanaka, Kanta
AU - Mosconi, Maria Giulia
AU - Takagi, Masahito
AU - Jäger, Rolf H.
AU - Muir, Keith
AU - Inoue, Manabu
AU - Schwab, Stefan
AU - Bonati, Leo H.
AU - Lyrer, Philippe A.
AU - Toyoda, Kazunori
AU - Caso, Valeria
AU - Werring, David J.
AU - Kallmünzer, Bernd
AU - Engelter, Stefan T.
AU - Engelter, Stefan T.
AU - Lyrer, Philippe A.
AU - Bonati, Leo H.
AU - Seiffge, David J.
AU - Traenka, Christopher
AU - Polymeris, Alexandros A.
AU - Zietz, Annaelle
AU - Peters, Nils
AU - Emsley, Hedley
PY - 2022/1/1
Y1 - 2022/1/1
N2 - 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 2022;91:78–88.
AB - 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 2022;91:78–88.
U2 - 10.1002/ana.26267
DO - 10.1002/ana.26267
M3 - Journal article
C2 - 34747514
AN - SCOPUS:85120034760
VL - 91
SP - 78
EP - 88
JO - Annals of Neurology
JF - Annals of Neurology
SN - 0364-5134
IS - 1
ER -