Dabigatran use in elderly patients with atrial fibrillation

Meytal Avgil-Tsadok; Cynthia Jackevicius; Vidal Essebag; Mark J. Eisenberg; Elham Rahme; Hassan Behlouli; Louise Pilote

doi:10.1160/TH15-03-0247

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2016; 115(01): 152-160
DOI: 10.1160/TH15-03-0247

Stroke, Systemic or Venous Thromboembolism

Schattauer GmbH Schattauer

Dabigatran use in elderly patients with atrial fibrillation

Meytal Avgil-Tsadok

¹Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada

,

Cynthia Jackevicius

²Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, California, USA

⁵University Health Network, Toronto, Canada

,

Vidal Essebag

⁶Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada

,

Mark J. Eisenberg

⁷Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada

,

Elham Rahme

³Institute for Clinical Evaluative Sciences, Toronto, Canada

,

Hassan Behlouli

¹Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada

,

Louise Pilote

¹Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada

› Institutsangaben

Abstract

Summary

In elderly patients (≥75 years), evidence of dabigatran efficacy is lacking and increased vigilance is warranted. We aimed to assess dabigatran effectiveness and safety in elderly patients in real-world practice. We conducted a population-based study using administrative databases, in Quebec (1999–2013). Dabigatran users (110/150 mg) were compared with matched warfarin users with regard to stroke and bleeding events. Age was categorised into < 75 or ≥ 75 years. Propensity score adjusted models were used. The cohort consisted of 15,918 dabigatran users and 47,192 matched warfarin users, with 67.3 % being elderly patients. The elderly predominantly used the lower dose (80.1 %) while younger patients mainly used the higher dose (80.0 %). In multivariable analyses adjusted for propensity score, the risk of stroke in elderly patients using dabigatran, was no different than the risk in warfarin users (HR 1.05, 95 % CI: 0.93, 1.19) regardless of dabigatran dose. However, dabigatran was associated with lower rates of intracranial haemorrhage (HR 0.60, 95 % CI: 0.47–0.76) and higher rates of gastrointestinal bleeding (HR 1.30 95 % CI: 1.14–1.50) when compared to warfarin. Based on real-life experience, dabigatran can offer an alternative to warfarin in elderly patients, with fewer intracranial bleeding events. However, caution is warranted for gastrointestinal bleeding.

Keywords

Anticoagulants - atrial fibrillation - bleeding - elderly - stroke

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Referenzen

References
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