VPB0573 - Real-life behavior of direct oral anticoagulants in the elderly population with atrial fibrillation

Background: The prevalence of atrial fibrillation (AF) increases with age. In the population over 80 years, this prevalence reaches 17%. However, despite being the majority population, the evidence about the use of direct oral anticoagulants (DOAC) in this subgroup is not clear, especially regarding to the risk of bleeding.

Aims: To analyze the safety and effectiveness of DOAC in the elderly population with AF (≥ 80 years).

Methods: Retrospective multicenter study that included patients with AF on treatment with DOAC (rivaroxaban, apixaban, dabigatran or edoxaban) between January 1, 2013 and December 31, 2016, in Spanish hospitals (Hospital Clínico Universitario Virgen de la Arrixaca, Hospital Comarcal del Noroeste and Hospital Vega Baja). Mortality, bleeding and thromboembolic rates were analyzed. Mean follow-up was 1.7 years. Statistical analysis was performed using the SPSS® program.

Results: A total of 2,492 patients with AF were included, of which 1,032 were ≥ 80 years. Table 1 shows the main characteristics of this population.
When comparing with the general population, a higher mortality rate in the elderly population (10.4 vs 3.8/100 patient-years, p< 0.001), and ischemic stroke (2.2 vs 1.4/100 patient-years, p=0.045) was observed, as well as a trend towards an increase in the rate of major bleeding (3.5 vs 2.6/100 patient-years, p=0.080) (Table 2). Most frequent major bleeding was digestive (57%).
After dividing the group into age ranges (65-74, 75-84 and ≥ 85 years), the mortality and ischemic stroke rates gradually increased. However, this dynamic was not exactly fulfilled for major bleeding.
In multivariate analysis, heart failure, chronic obstructive pulmonary disease and neoplasia were significantly associated with increased mortality, while valvulopathy and neoplasia were predictors of major bleeding.

Conclusion(s): The elderly population is especially susceptible, with a higher mortality and ischemic stroke rates, which progressively increase with age. The rate of major bleeding also tends to increase with age.