Prevention of stroke in elderly patients with a trial fibrillation: possibilities of Apixaban
https://doi.org/10.37586/2686-8636-2-2020-138-146
Abstract
In review article, we discuss the opportunity of use of one of the direct oral anticoagulants – apixaban – for prevention of stroke and/or systemic embolism in elderly patients with non-valvular a trial fibrillation. We consider results of randomized clinical trials of apixaban – ARISTOTLE and AVERROES, including the subgroups analysis in patients in the age of ≥75 years and ≥80 years – in ARISTOTLE, ≥75 years and ≥85 years – in AVERROES. These studies have shown that elderly patients had more benefit from apixaban administration than warfarin (in ARISTOTLE) or acetylsalicylic acid (in AVERROES). The results of two retrospective observational studies confirming the favorable profile of apixaban effectiveness and safety in elderly patients with a trial fibrillation in real clinical practice, and the main provisions of the consensus document FORTA, the purpose of which is to individualize treatment of elderly patients based on clinical characteristics of the patient, are also considered.
About the Authors
N. M. Vorobyeva
Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Russian Clinical and Research Center of Gerontology
Russian Federation
Russian Federation
MD, PhD, Head of Laboratory of Cardiovascular Aging
+7(915) 192-22-78
Moscow
O. N. Tkacheva
Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Russian Clinical and Research Center of Gerontology
Russian Federation
Russian Federation
MD, PhD, professor, Director
+7(499) 187-64-67
Moscow
References
1. Schnabel R.B., Yin X., Gona P., Larson M.G., Beiser A.S., McManus D.D. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015; 386: 154–162. DOI: 10.1016/S0140-6736(14)61774-8.
2. Go A.S., Hylek E.M., Phillips K.A., Chang Y., Henault L. E., Selby J.V. et al. Prevalence of diagnosed a trial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285: 2370–2375. DOI: 10.1001/jama.285.18.2370.
3. Lloyd-Jones D.M., Wang T.J., Leip E.P., Larson M. G., Levy D., Vasan R. S. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004; 110: 1042–1046. DOI: 10.1161/01.CIR.0000140263.20897.42.
4. Connolly S.J., Ezekowitz M.D., Yusuf S., Eikelboom J., Oldgren J., Parekh A. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361: 1139–1151. DOI: 10.1056/NEJMoa0905561.
5. Patel M.R., Mahaffey K.W., Garg J., Pan G., Singer D.E., Hacke W. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365: 883–891. DOI: 10.1056/NEJMoa1009638.
6. Granger C.B., Alexander J.H., McMurray J.J., Lopes R.D., Hylek E.M., Hanna M. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365: 981–992. DOI: 10.1056/NEJMoa1107039.
7. Turagam M.K., Velagapudi P., Flaker G.C. Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants. Clin Interv Aging. 2015; 10: 1431–1444. DOI: 10.2147/CIA.S80641.
8. Halvorsen S., Atar D., Yang H., De Caterina R., Erol C., Garcia D. et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J. 2014; 35: 1864–1872. DOI: 10.1093/eurheartj/ehu046.
9. Rao M.P., Vinereanu D., Wojdyla D.M., Alexander J.H., Atar D., Hylek E.M. et al. Clinical Outcomes and History of Fall in Patients with Atrial Fibrillation Treated with Oral Anticoagulation: Insights From the ARISTOTLE Trial. Am J Med. 2018; 131: 269–275.e2. DOI: 10.1016/j.amjmed.2017.10.036.
10. Connolly S.J., Eikelboom J., Joyner C., Diener H.C., Hart R., Golitsyn S. et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011; 364: 806– 817. DOI: 10.1016/j.jcin.2016.10.023.
11. Ng K.H., Shestakovska O., Connolly S.J., Eikelboom J.W., Avezum A., Diaz R. et al. Efficacy and safety of apixaban compared with aspirin in the elderly: a subgroup analysis from the AVERROES trial. Age Ageing. 2016; 45: 77–83. DOI: 10.1093/ageing/afv156.
12. Deitelzweig S., Luo X., Gupta K., Trocio J., Mardekian J., Curtice T. et al. Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients.Curr Med Res Opin. 2017; 33: 1745–1754. DOI: 10.1080/03007995.2017.1334638.
13. Li X., Deitelzweig S., Keshishian A., Hamilton M., Horblyuk R., Gupta K. et al. Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in «real-world» clinical practice. A propensity-matched analysis of 76,940 patients. Thromb Haemost. 2017; 117: 1072–1082. DOI: 10.1160/TH17-01-0068.
14. Diener H.-C., Aisenberg J., Ansell J., Atar D., Breithardt G., Eikelboom J. et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2. Eur Heart J. 2017; 38: 860–868. DOI: 10.1093/eurheartj/ehw069.
15. Wehling M. Drug therapy in the elderly: too much or too little, what to do? A new assessment system: fit for the aged (FORTA) [in German]. Dtsch Med Wochenschr. 2008; 133: 2289–2291. DOI: 10.1055/s-0028-1091275.
16. Wehling M. Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug classification: fit for the aged. J Am Geriatr Soc. 2009; 57: 560–561. DOI: 10.1111/j.1532-5415.2009.02131.x.
17. Kuhn-Thiel A.M., Weis C., Wehling M. FORTA authors/expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014; 31: 131–140. DOI: 10.1007/s40266-013-0146-0.
18. Wehling M., Collins R., Gil V.M., Hanon O., Hardt R., Hoffmeister M. et al. Appropriateness of oral anticoagulants for the long-term treatment of atrial fibrillation in older people. Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016). Drugs Aging. 2017; 34: 499–507. DOI: 10.1007/s40266-017-0466-6.
Review
For citations:
Vorobyeva N.M., Tkacheva O.N. Prevention of stroke in elderly patients with a trial fibrillation: possibilities of Apixaban. Russian Journal of Geriatric Medicine. 2020;(2):138-146. (In Russ.) https://doi.org/10.37586/2686-8636-2-2020-138-146
Views:
788
Email this article 