Journal of Thrombosis and Thrombolysis

, Volume 49, Issue 1, pp 42–53 | Cite as

Clinical profile of direct oral anticoagulants versus vitamin K anticoagulants in octogenarians with atrial fibrillation: a multicentre propensity score matched real-world cohort study

  • Vincenzo RussoEmail author
  • Emilio Attena
  • Marco Di Maio
  • Carmine Mazzone
  • Andreina Carbone
  • Valentina Parisi
  • Anna Rago
  • Antonio D’Onofrio
  • Paolo Golino
  • Gerardo Nigro


Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followed by the participating centers, through outpatient visits every 3 to 6 months. The database was queried for AF patients aged ≥ 80 years who received DOACs or VKAs treatment. The primary effectiveness endpoint was the occurrence of thromboembolic events (a composite of stroke, transient ischemic attack, systemic embolism); the primary safety endpoint was the occurrence of major bleeding; the secondary endpoint was all-cause mortality. The database query identified 774 AF patients aged ≥ 80 years treated with VKAs and 279 with DOACs. Propensity score (2:1) matching selected 252 DOAC and 504 VKA recipients. The mean follow-up was 31.07 ± 14.09 months. The incidence rate of thromboembolic events was 13.79 per 1000 person-years [14.80 in DOAC vs 13.34 in VKA group, Hazard Ratio 1.10; 95% confidence interval (CI) 0.49 to 2.45; P = 0.823]. The incidence rate of intracranial hemorrhage (ICH) was 8.06 per 1000 person-years (3.25 in DOAC vs 10.23 in VKA group, HR 0.33; 95% CI 0.07 to 1.45; P = 0.600). Through these incidence rates, we found a positive net clinical benefit (NCB) of DOACs over VKAs, equal to + 9.01. The incidence rate of all-cause mortality was 105.05 per 1000 person-years (74.67 in DOAC vs 118.67 in VKA group, Hazard Ratio 0.65; 95% CI 0.47 to 0.90; P = 0.010). The concomitant use of antiinflammatory drugs (HR 7.90; P < 0.001) were found to be independent predictor of major bleeding. Moreover, age (HR 1.17; P < 0.002) and chronic kidney disease (HR 0.34; P = 0.019) were found to be independently associated with thromboembolic events. In our study no significant difference in terms of both thromboembolic and major bleeding events, but a significant lower incidence of all-cause mortality, was detected in AF patients aged ≥ 80 years treated with DOACs vs VKAs.


Atrial fibrillation Direct oral anticoagulant Octogenarians Net clinical benefit Effectiveness Safety Major bleeding Thromboembolic events 



No funding was received for this work.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

The procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Vincenzo Russo
    • 1
    Email author
  • Emilio Attena
    • 2
  • Marco Di Maio
    • 1
  • Carmine Mazzone
    • 3
  • Andreina Carbone
    • 1
  • Valentina Parisi
    • 4
  • Anna Rago
    • 1
  • Antonio D’Onofrio
    • 5
  • Paolo Golino
    • 1
  • Gerardo Nigro
    • 1
  1. 1.Chair of Cardiology, Department of Translational Medical SciencesUniversity of Campania “Luigi Vanvitelli” – Monaldi HospitalNaplesItaly
  2. 2.Department of CardiologyHealth Authority Naples 2 NordNaplesItaly
  3. 3.Cardiovascular CentreTriesteItaly
  4. 4.Department of Translational Medical SciencesUniversity of Naples Federico IINaplesItaly
  5. 5.Departmental Unit of Electrophysiology, Evaluation and Treatment of ArrhythmiasMonaldi HospitalNaplesItaly

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