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New Oral Anticoagulants in Older Adults

June 3, 2014

New Oral Anticoagulants in Older Adults

  1. Allan S. Brett, MD

For patients 75 or older, the balance of efficacy and bleeding risk appears similar to that of younger patients.

  1. Allan S. Brett, MD

Clinicians might be concerned about the relative safety of the newer oral anticoagulants (dabigatran [Pradaxa], rivaroxaban [Xarelto], and apixaban [Eliquis]) in older patients. In this meta-analysis, researchers identified 10 randomized trials in which outcomes for these three agents were presented according to age subgroups; the analysis focused on the 25,000 older patients (age, ≥75). These trials involved patients with atrial fibrillation, acute venous thromboembolism (VTE), extended treatment to prevent recurrent VTE, and prophylaxis in medically ill patients. Comparators were warfarin, aspirin, enoxaparin, and placebo (placebo was used only in 2 extended VTE–prevention trials).

For older patients, rates of major bleeding or “clinically relevant bleeding” were virtually identical in the new-anticoagulant and conventional-treatment groups; this finding held true for studies in which new agents were compared with warfarin. Incidences of stroke (in the atrial fibrillation trials) and recurrent VTE or death (in the VTE trials) were significantly lower with new agents than with comparators. These efficacy and safety findings for older patients applied to each of the three individual agents.

Comment

This analysis provides reassurance that the balance of efficacy and safety of dabigatran, rivaroxaban, and apixaban extends to older patients. Prescribing information for the new drugs specifies dose reductions (or contraindications) for patients with reduced renal function, but the manufacturers do not mandate adjustments in drug dose based on advanced age alone.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

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