The safety of direct oral anticoagulants in patients with atrial fibrillation and aged ≥ 85 years has been evaluated in a prospective Slovenian study. There were 2,260 patients with atrial fibrillation aged ≥ 65, who received dabigatran, rivaroxaban or apixaban treatment for a mean duration of 735 days. 106 patients suffered major bleeding during the follow-up period (2.3%/year). Despite being treated with reduced doses, patients aged ≥ 85 years had the highest risk of any major bleeding (hazard ratio [HR] 2.50, 95% CI 1.44–4.32, p = 0.001), intracranial bleeding (HR 4.74, 95% CI 1.48–15.14, p < 0.01) and major gastrointestinal bleeding (HR 2.32, 95% CI 1.10–4.89, p < 0.03), in comparison to patients aged 65-74 years. The researchers identified that age group ≥ 85 years (HR 2.52, 95% CI 1.43–4.47, p = 0.001) and history of bleeding (HR 3.32, 95% CI 1.87–5.90, p < 0.001) were strong predictors of major bleeding, and reported a 1.3%/year incidence of a composite of stroke, transient ischaemic attack and systemic embolism. From these results, it is clear that the highest risk of major bleeding is seen among the oldest elderly patients with atrial fibrillation, and is further increased with a history of bleeding. See the original paper here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh