Atrial fibrillation in elderly patients. Features of using rivaroxaban

Abstract

The problem of anticoagulant treatment of elderly patients with atrial fibrillation (AF) is very topical for everyday medical practice because, on the one hand, the proportion of elderly patients among those who have AF is constantly increasing, and, on the other hand, there is no doubt that treatment of elderly patients involves many problems associated with a large number of complications. This material reviews the choice of optimal anticoagulant therapy for older AF patients and focuses on the use of rivaroxaban. Clinical research data show that rivaroxaban is one of the optimal drugs of choice for older patients. Thus, a comparative meta-analysis of the safety of various non-vitamin-K oral anticoagulants (NOAC) in patients of ≥75 years of age (in AF and deep vein thrombosis) showed that administration of rivaroxaban in comparison with warfarin was associated with an almost twofold significantly lower frequency of fatal bleedings (HR 0.53; 95% Cl 0.30-0.93; p = 0.03). According to the ROCKET-AF study, intake of rivaroxaban in elderly patients was comparable in efficiency and safety profile to warfarin. Since renal dysfunction is common in older patients with AF, safety issues are very important. In a ROCKET-AF study, the use of rivaroxaban in patients with moderate renal dysfunction was known to be associated with a lower frequency of fatal bleeding (0.28 vs. 0.74 per 100 patients/ year; HR 0.39; 95% CI 0.15-0.99; p = 0.047) than that of warfarin. Given the high probability of development of exacerbation of IHD in elderly patients with AF, they need an anticoagulant that maximally protects them from acute coronary complications. In the meta-analysis of 28 randomized trials with NOAC, only rivaroxaban was associated with a significant reduction by 22% in the risk of myocardial infarction and acute coronary syndrome compared to other control drugs. In conclusion, it can be stated that rivaroxaban may be a good choice for anticoagulant treatment specifically for elderly patients with AF, especially given its efficacy and safety profile and the adherence of patients to therapy.