Limited literature has established the role of direct oral anticoagulants (DOAC) for elderly patients with non-valvular atrial fibrillation (NVAF) who are unsuited for warfarin. The objectives of this study, therefore, were to assess the effectiveness and safety of DOAC use in this vulnerable patient population. This was a retrospective propensity score matching (PSM) cohort study. Among all patients ages 75+ who were not candidates for warfarin, we matched those who initiated DOAC between September 2017 and September 2018 to those who did not receive DOAC nor warfarin in a 1:1 ratio. Effectiveness outcome was a composite measure of stroke, transient ischemic attack, and pulmonary embolism. Safety outcome was a composite measure of non-trauma related intracranial hemorrhage and gastrointestinal bleed. Unless patients died or lost membership, follow-up period for the effectiveness outcome was until end of 2019, while the safety outcome was for a period up to 1 year. Conditional logistic regression was used to analyze both outcomes. We identified 7,818 patients who met the inclusion criteria and started DOAC, which matched to 7,818 patients who did not receive anticoagulants. The mean age was 82.3±5.1 years and 51.5% male. The DOAC group had a lower hazard ratio (HR) of 0.37 (0.24-0.57 CI, p<0.01) for composite effectiveness outcomes while no difference in the composite safety outcome (HR 0.91, 0.65-1.25 CI, p=0.55) when compared to matched control. In conclusion, DOAC was found to be effective in preventing thromboembolic events in patients ages 75+ with NVAF who were not eligible for warfarin.

中文翻译：

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在现实环境中评估直接口服抗凝剂对不适合使用华法林的老年非瓣膜性心房颤动患者的有效性和安全性。

有限的文献证实了直接口服抗凝剂 (DOAC) 对于不适合使用华法林的老年非瓣膜性心房颤动 (NVAF) 患者的作用。因此，本研究的目的是评估 DOAC 在这一弱势患者群体中使用的有效性和安全性。这是一项回顾性倾向评分匹配（PSM）队列研究。在所有不适合接受华法林的 75 岁以上患者中，我们将 2017 年 9 月至 2018 年 9 月期间开始接受 DOAC 的患者与未接受 DOAC 或华法林的患者按 1:1 的比例进行匹配。有效性结果是中风、短暂性脑缺血发作和肺栓塞的综合衡量标准。安全性结果是非创伤相关颅内出血和胃肠道出血的综合衡量标准。除非患者死亡或失去会员资格，否则有效性结果的随访期至 2019 年底，而安全性结果的随访期最长为 1 年。使用条件逻辑回归来分析这两个结果。我们确定了 7,818 名符合纳入标准并开始 DOAC 的患者，这与 7,818 名未接受抗凝药物的患者相匹配。平均年龄为 82.3±5.1 岁，其中 51.5% 为男性。相比之下，DOAC 组的复合有效性结果的风险比 (HR) 较低，为 0.37 (0.24-0.57 CI，p<0.01)，而复合安全性结果没有差异 (HR 0.91，0.65-1.25 CI，p=0.55)到匹配控制。总之，DOAC 可有效预防 75 岁以上不适合使用华法林的 NVAF 患者的血栓栓塞事件。