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Thromb Haemost 2016; 115(01): 152-160
DOI: 10.1160/TH15-03-0247
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH Schattauer

Dabigatran use in elderly patients with atrial fibrillation

Meytal Avgil-Tsadok
1   Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada
,
Cynthia Jackevicius
2   Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, California, USA
5   University Health Network, Toronto, Canada
,
Vidal Essebag
6   Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
,
Mark J. Eisenberg
7   Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
,
Elham Rahme
3   Institute for Clinical Evaluative Sciences, Toronto, Canada
,
Hassan Behlouli
1   Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada
,
Louise Pilote
1   Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada
› Author Affiliations Financial support: Financial support for this study was provided by an operating grant from the Canadian Institutes of Health Research (grant number MOP-84304).
Further Information

Publication History

Received: 23 March 2015

Accepted after major revision: 10 July 2015

Publication Date:
22 November 2017 (online)

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Summary

In elderly patients (≥75 years), evidence of dabigatran efficacy is lacking and increased vigilance is warranted. We aimed to assess dabigatran effectiveness and safety in elderly patients in real-world practice. We conducted a population-based study using administrative databases, in Quebec (1999–2013). Dabigatran users (110/150 mg) were compared with matched warfarin users with regard to stroke and bleeding events. Age was categorised into < 75 or ≥ 75 years. Propensity score adjusted models were used. The cohort consisted of 15,918 dabigatran users and 47,192 matched warfarin users, with 67.3 % being elderly patients. The elderly predominantly used the lower dose (80.1 %) while younger patients mainly used the higher dose (80.0 %). In multivariable analyses adjusted for propensity score, the risk of stroke in elderly patients using dabigatran, was no different than the risk in warfarin users (HR 1.05, 95 % CI: 0.93, 1.19) regardless of dabigatran dose. However, dabigatran was associated with lower rates of intracranial haemorrhage (HR 0.60, 95 % CI: 0.47–0.76) and higher rates of gastrointestinal bleeding (HR 1.30 95 % CI: 1.14–1.50) when compared to warfarin. Based on real-life experience, dabigatran can offer an alternative to warfarin in elderly patients, with fewer intracranial bleeding events. However, caution is warranted for gastrointestinal bleeding.

Keywords

Anticoagulants - atrial fibrillation - bleeding - elderly - stroke
 

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