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M Ruiz Ortiz, M A Esteve-Pastor, P Rana Miguez, F Marin, M Martinez-Selles, I Roldan, J Muniz, A Cequier, V Bertomeu, M Anguita, FANTASIIA Study Investigators, P6284
Effectiveness and safety of direct anticoagulants versus vitamin K antagonists in octogenarians patients with atrial fibrillation in a “real world” nationwide registry, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy566.P6284, https://doi.org/10.1093/eurheartj/ehy566.P6284Close - Share Icon Share
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Background and aims: Our objective was to describe basal features and major events at follow up in patients aged ≥80 years with atrial fibrillation (AF) included in an observational “real world” registry, according to the use of vitamin K antagonists (VKA) versus direct oral anticoagulants (DOAC) Method: The FANTASIIA registry prospectively included outpatients with AF and anticoagulant treatment (per protocol, proportion of VKA and DOAC was 4:1), consecutively recruited from 1.6.2013 to 15.10.2014 in 50 Spanish centers. Basal features, embolic events (stroke and systemic embolism), severe bleedings and all-cause mortality rates after up to three years of follow-up were investigated in patients aged ≥80 years included in the study, according to the anticoagulant treatment received.
Results: A total of 578 patients were included in the study (mean age 84.0±3.4 years, 44.3% male). The 123 patients (21.3%) who received DOACs presented a lower frequency of renal failure (21.1% vs. 32.2%, p=0.02), cancer history (4.9% vs. 10.9%, p=0.046), dilated cardiomyopathy or left ventricular dysfunction (2.4% vs. 8.0%, p=0.03) and permanent AF (52.9% vs. 61.6%, p=0.01); and higher frequency of previous stroke (26.0% vs. 16.6%, p=0.02), previous major bleeding (8.1% vs. 3.6%, p=0.03) and initial diagnosis by a cardiologist (74.8% vs. 61.9%, p=0.02) versus the 455 patients (78.7%) treated with VKAs. There were no significant differencies in Charlson, CHADS2, CHA2DS2VASc nor HASBLED scores: 1.11±0.98 vs. 1.17±1.12, 2.91±1.18 vs. 2.75±1.08, 4.69±1.3 vs. 4.47±1.25 and 2.36±1.05 vs. 2.39±0.9, respectively. After up to three years of follow up, a total of 1338 patients-year of observation accumulated. Rates of embolic events, severe bleedings and all cause death (per 100 patients-year) were (ACODs vs VKAs): 0.34 vs. 1.35 (p=0.15), 3.45 vs. 4.41 (p=0.48) and 8.2 vs. 11.0 (p=0.18), respectively. After adjusting for confounding factors in multivariate analysis, we did not found significant differences between both treatments (HR 0.25, 95% CI 0.03–1.93, p=0.19 for embolic events, HR 0.88, 95% CI 0.44–1.76, p=0.72 for severe bleedings, and HR 0.84, 95% CI 0.53–1.33, p=0.46 for all-cause death).
