PMID- 35185404
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220223
IS  - 1520-765X (Print)
IS  - 1554-2815 (Electronic)
IS  - 1520-765X (Linking)
VI  - 24
IP  - Suppl A
DP  - 2022 Feb
TI  - Non-vitamin K antagonist oral anticoagulants in older and frail patients with 
      atrial fibrillation.
PG  - A1-A10
LID - 10.1093/eurheartj/suab150 [doi]
AB  - Elderly and frail patients with atrial fibrillation (AF) are at increased risk of 
      thrombotic events, bleeding, and death compared to their counterparts, making 
      their management challenging. With the introduction of non-vitamin K antagonist 
      (VKA) oral anticoagulants (NOACs) in the past decade, the risk:benefit balance in 
      such high-risk patients with AF has tipped in favor of treating these patients 
      with anticoagulation, and in most cases with a NOAC instead of a VKA. In patients 
      >/=75 years of age with AF, each of the 4 approved NOACs reduced stroke or systemic 
      embolism and vs warfarin in their landmark clinical trial and lowered mortality. 
      However, only apixaban and edoxaban significantly reduced major bleeding vs 
      warfarin. A similar pattern was seen in even older cohorts (>/=80 and >/=85 years). 
      Among patients age >/=80 who are not candidates for oral anticoagulants at the 
      approved dose, edoxaban 15 mg may be a reasonable alternative. In elderly or 
      frail individuals who are on multiple comedications (particularly if >/=1 moderate 
      or strong cytochrome P-450 inhibitor), only edoxaban consistently reduced major 
      bleeding compared to warfarin. Regardless of the specific OAC selected, 
      appropriate dosing in the elderly (who frequently qualify for dose reduction per 
      the prescribing label) is critical. In elderly and frail patients with AF, 
      factors that may modify the efficacy-safety profile of specific oral OACs should 
      be carefully considered to permit the optimal selection and dosing in these 
      vulnerable patients.
CI  - Published on behalf of the European Society of Cardiology. (c) The Author(s) 2022.
FAU - Giugliano, Robert P
AU  - Giugliano RP
AD  - Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 
      TIMI Study Office , Hale BTM, Suite 7022, 60 Fenwood Road, Boston, MA 02115, USA.
LA  - eng
PT  - Journal Article
DEP - 20220214
PL  - England
TA  - Eur Heart J Suppl
JT  - European heart journal supplements : journal of the European Society of 
      Cardiology
JID - 100886647
PMC - PMC8850712
OTO - NOTNLM
OT  - NOAC
OT  - atrial fibrillation
OT  - elderly
OT  - frail
OT  - oral anticoagulant
EDAT- 2022/02/22 06:00
MHDA- 2022/02/22 06:01
PMCR- 2022/02/14
CRDT- 2022/02/21 06:00
PHST- 2022/02/21 06:00 [entrez]
PHST- 2022/02/22 06:00 [pubmed]
PHST- 2022/02/22 06:01 [medline]
PHST- 2022/02/14 00:00 [pmc-release]
AID - suab150 [pii]
AID - 10.1093/eurheartj/suab150 [doi]
PST - epublish
SO  - Eur Heart J Suppl. 2022 Feb 14;24(Suppl A):A1-A10. doi: 
      10.1093/eurheartj/suab150. eCollection 2022 Feb.