Geriatric characteristics such as high age, multi-morbidity,
polypharmacy and
frailty are common in patients with
atrial fibrillation (AF). In a retrospective study using a German claims database, effectiveness (
ischaemic stroke/systemic
embolism) and safety (intracerebral, gastrointestinal and major extracranial
bleeding) were compared in patients with non-valvular AF starting non-
vitamin K oral antagonists (NOACs) (
apixaban,
dabigatran and
rivaroxaban) and
phenprocoumon. Cox proportional hazards models were used to calculate adjusted hazard ratios, and interaction terms of the treatment group and geriatric status (defined by age ≥75 years,
frailty, ≥ 4 co-morbidities and
polypharmacy) were entered into the model. A total of 42,562 and 27,939 patients initiated
NOAC and
phenprocoumon treatment (mean age 74 years ± 11, 51% male) with a follow-up time of 147,785 person-years. Note that 52.9% of patients were elderly, 50.8% were frail, 37.0% were co-morbid and 46.5% had
polypharmacy.
NOAC use was not associated with effectiveness and gastrointestinal
bleeding, neither in geriatric nor in non-geriatric patients. The hazard of major extracranial and intracranial
bleeding was significantly decreased for
NOAC use, with similar risk reduction in geriatric and non-geriatric patients: major extracranial
bleeding 0.70 (95% confidence interval [CI], 0.56-0.87) to 0.73 (95% CI, 0.60-0.89) for the geriatric groups and 0.71 (95% CI, 0.56-0.93) to 0.76 (0.59-0.98) for the non-geriatric groups (p-values for interaction > 0.6); and intracranial
bleeding 0.52 (95% CI, 0.39-0.69) to 0.59 (95% CI, 0.47-0.73) for the geriatric groups and 0.54 (95% CI, 0.37-0.79) to 0.65 (95% CI, 0.49-0.86) for the non-geriatric groups (p-values for interaction > 0.2). Hence, NOACs showed similar effectiveness and superior safety in geriatric and non-geriatric patients.