Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older.

Patrick Manckoundia,Jérémy Barben,Valentine Nuss,Didier Menu,Gilles Nuemi,Jérémie Vovelle,Camille Baudin-Senegas,Alain Putot,Clémentine Rosay,Arthur Hacquin

doi:10.3390/ijerph18094443

Abstract

The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than those taking DOACs (87.11 vs. 86.35 years). In the DOAC group, there were more women (51.92% vs. 48.25%) (p = 0.043), less RCD (89.60% vs. 92.73%) (p = 0.002), less VTE (1.80% vs. 6.59%), less severe heart failure (58.09% vs. 67.87%), less severe hypertension (18.22% vs. 23.60%), less severe kidney diseases (1.49% vs. 3.82%), and fewer drugs per prescription (6.15 vs. 6.66) (p < 0.01 for all). The DOAC group were also less likely to be taking angiotensin receptor blockers (10.79% vs. 13.97%), furosemide (40.81% vs. 49.66%) or digoxin (10.32% vs. 13.66%) than the VKA group (p = 0.009, p < 0.001, and p = 0.005). DOACs were less prescribed than VKAs. Individuals taking VKAs were older and had more severe comorbidities and more drugs per prescription than those taking DOACs.

Highlights

The number of healthy older persons and frail older individuals is increasing worldwide due to the increase in life expectancy [1]
The mean number of registered chronic diseases (RCD) was significantly lower in the direct oral anticoagulants (DOAC) group than in the vitamin K antagonists (VKA) group, 1.80 ± 1.17 and 2.07 ± 1.22, respectively (p < 0.001)
There were more refill prescriptions than novel prescriptions in both groups, with significantly less novel prescriptions in the DOAC group than in the VKA group, 7.35% and 11.62%, respectively (p < 0.001)

Summary

Introduction

The number of healthy older persons and frail older individuals is increasing worldwide due to the increase in life expectancy [1]. The frequency of cardiovascular, cerebrovascular, and vascular diseases increases with advancing age as a result of the independent effect of aging, and because the number of risk factors increases with age [2]. Cardiovascular and cerebrovascular events in older persons result in a higher rate of long-term disability and dependence [3]. As well as curative treatment of the vast majority of cardiovascular, cerebrovascular, and peripheral vascular events, such as atrial fibrillation (AF) and venous thromboembolism (VTE), require antithrombotic therapy [4,5]. Of the two main oral anticoagulants, vitamin K antagonists (VKA) are the oldest on the market. VKAs have been used since the 1940s when warfarin was approved for

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