Safety of Non-Vitamin K Oral Anticoagulants in Elderly Patients with Atrial Fibrillation

Abstract

Aim. To study the safety of non-vitamin K oral anticoagulants (NOAC) in patients with atrial fibrillation (AF) over 75 years old. Material and methods. The observation study included patients ≥75 years of age with confirmed AF, receiving dabigatran in a reduced dosage, apixaban or rivaroxaban in full or reduced dosage. Previous experience of NOAC treatment from the very beginning of therapy, if a patient was ≥75 years old, or from the point a patient reached 75 years was considered; episodes of NOAK change, as well as hemorrhagic and ischemic events associated with taking an anticoagulant, were recorded. Patient groups were comparable in risk score by CHA2DS2-VASc and HAS-BLED scales. Results. Patients with AF (n=102; 39 men and 63 women; an average age 79.4Ѓ}4.1 years) were included: 32 patients were in dabigatran group, 34 patients – in apixaban group and 36 patients – in rivaroxaban group. 19 clinically significant bleedings were recorded, 10 occurred in patients taking dabigatran and 9 in those taking rivaroxaban. No hemorrhagic events in patients treated with apixaban were observed. Hematuria (31.6%), large subcutaneous hematomas (26.3%) and intensive nasal bleedings (26.3%) were the most frequent events. No ischemic cardioembolic stroke was recorded. Conclusions. In elderly patients, all NOAC (dabigatran, rivaroxaban and apixaban) demonstrated good safety profile without major bleeding within a 1.5-year follow-up period.