Oral Anticoagulation for Atrial Fibrillation in Octogenarians Across the Renal Function Spectrum

Andreina Carbone; Roberta Bottino; Emilio Attena; Valentina Parisi; Maddalena Conte; Antonello D'Andrea; Egidio Imbalzano; Caturano Alfredo; Vincenzo Russo

doi:10.1007/s10557-023-07539-9

Oral Anticoagulation for Atrial Fibrillation in Octogenarians Across the Renal Function Spectrum

Cardiovasc Drugs Ther. 2023 Dec 18. doi: 10.1007/s10557-023-07539-9. Online ahead of print.

Authors

Andreina Carbone¹, Roberta Bottino², Emilio Attena³, Valentina Parisi⁴, Maddalena Conte⁴, Antonello D'Andrea⁵, Egidio Imbalzano⁶, Caturano Alfredo⁷, Vincenzo Russo³

Affiliations

¹ Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Napoli, Italy. andr.carbone@gmail.com.
² Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Napoli, Italy.
³ Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Naples, Naples, Italy.
⁴ Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
⁵ Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Italy.
⁶ Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
⁷ Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.

PMID: 38108919
DOI: 10.1007/s10557-023-07539-9

Abstract

Purpose: Our study aimed to describe the efficacy and safety of oral anticoagulation (OAC) use in octogenarians with atrial fibrillation (AF) across the spectrum of renal function.

Methods: Data for this study were sourced from AF Research Database (NCT03760874). AF patients aged ≥ 80 who received OAC treatment, both direct oral anticoagulant (DOAC) and vitamin K antagonist (VKA) were selected. Participants were categorized in 2 groups according to creatinine clearance (CrCl) ≥ 45 and < 45 ml/min/1.73 m². The primary safety outcome was the occurrence major bleeding. The primary effectiveness outcome was the occurrence of thromboembolic events.

Results: A total of 901 AF patients (median age 84 [4.9] years; 44% men) with age ≥ 80 years on treatment with DOACs (n: 629, 70%) and VKA (n: 272, 30%) were included in the study. 303 patients (34%) had CrCl < 45 ml/min/1.73m2 and 598 (66%) had CrCl ≥ 45 ml/min/1.73m2. No significant differences were shown in major bleedings, minor bleedings and thromboembolic events between patients on DOACs vs VKAs, both in the group with CrCl ≥ 45 than < 45 ml/min. In the group with CrCl < 45 ml/min/1.73 m², a total of 72 patients (23%) died during the follow-up, with higher mortality in VKA group compared to DOACs (45% vs 15%; p < 0.001). At multivariate regression analysis, age [OR: 1.15; p = 0.001] and coronary artery disease (CAD) [OR: 1.74; p = 0.04] were independently associated with mortality; in contrast, the use of DOACs were inversely associated with mortality [OR = 0.26; p < 0.001]. In patients with CrCl ≥ 45 ml/min/1.73 m², DOACs group experienced less intra-cranial hemorrhage (ICH) (0.2% vs 2.8%; p = 0.01) compared to VKAs. VKAs patients showed higher mortality compared to those on DOACs (29.1% vs 7.9%; p < 0.001). At multivariate regression analysis, chronic heart failure [OR = 2.14; p = 0.01] was independently associated with death, whereas male gender [OR: 0.45; p = 0.009] and the use of DOACs [OR: 0.29; p < 0.001] were associated with lower mortality.

Conclusion: DOACs seem to be safe and effective in octogenarians with chronic kidney disease at stage ≥ G3b. As compared with VKA administration, the use of DOACs was associated with lower mortality rates among AF octogenarians with renal dysfunction.

Keywords: Anticoagulation; Atrial fibrillation; Chronic kidney disease; Elderly; Stroke prevention.