Background the efficacy and safety of direct oral anticoagulants (DOACs) compared with that of warfarin in very old patients with non-valvular atrial fibrillation (NVAF) have been reported in terms of thromboembolisms and bleeding. However, the association of DOAC use and mortality in such patients remains unclear. Objectives this study aimed to investigate the incidence of mortality, as well as thromboembolisms and major bleeding, in very old patients with NVAF using DOACs as compared with warfarin. Methods we conducted a single-centre historical cohort study of consecutive patients with NVAF aged ≥80 years who used oral anticoagulants. We compared the 5-year outcomes (all-cause mortality, thromboembolism, major bleeding and intracranial haemorrhage) between the DOAC and Warfarin groups. Results of 1,676 patients with atrial fibrillation aged 80 years and over, 1,208 with NVAF were included. Propensity score matching provided 461 patients in each group, and the risk of all-cause mortality, thromboembolisms, major bleeding and intracranial haemorrhages was significantly lower in the DOAC group than Warfarin group (hazard ratio [95% confidence interval] for DOAC use, 0.68 [0.54–0.87], 0.31 [0.19–0.53], 0.56 [0.36–0.88], 0.23 [0.10–0.56], log-rank P = 0.002, P < 0.001, P = 0.010, P < 0.001). The mortality rate within 1 year after major bleeding was significantly lower in the DOAC group than Warfarin group (14% versus 38%, P = 0.03), however, that after a thromboembolism was similar between the two groups (33% versus 35%). Conclusion patients with NVAF aged ≥80 years and using DOACs had a lower mortality than those using warfarin.

中文翻译：

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直接口服抗凝剂对高龄非瓣膜性心房颤动患者死亡率的影响

背景 与华法林相比，直接口服抗凝剂 (DOAC) 在血栓栓塞和出血方面的疗效和安全性已被报道用于非常老年的非瓣膜性心房颤动 (NVAF) 患者。然而，这些患者中 DOAC 的使用与死亡率之间的关系仍不清楚。目的 本研究旨在调查使用 DOAC 与华法林相比的非常老年 NVAF 患者的死亡率、血栓栓塞和大出血的发生率。方法 我们对连续使用口服抗凝剂的≥80 岁 NVAF 患者进行了单中心历史队列研究。我们比较了 DOAC 组和华法林组之间的 5 年结局（全因死亡率、血栓栓塞、大出血和颅内出血）。结果 1, 纳入 80 岁及以上房颤患者 676 例，其中 NVAF 患者 1208 例。倾向评分匹配在每组中提供了 461 名患者，DOAC 组的全因死亡、血栓栓塞、大出血和颅内出血风险显着低于华法林组（DOAC 使用的风险比 [95% 置信区间]，0.68 [0.54–0.87], 0.31 [0.19–0.53], 0.56 [0.36–0.88], 0.23 [0.10–0.56], 对数秩 P = 0.002, P < 0.001, P = 0.010, P < 0.001)。DOAC 组大出血后 1 年内的死亡率显着低于华法林组（14% 对 38%，P = 0.03），然而，两组之间血栓栓塞后的死亡率相似（33% 对 35%） . 结论 ≥80 岁的 NVAF 患者使用 DOACs 的死亡率低于使用华法林的患者。