AGE AND EFFECTIVENESS AND SAFETY OF VARIOUS ANTITHROMBOTIC THERAPY VARIANTS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION
https://doi.org/10.15829/1728-8800-2013-1-46-53
Abstract
Aim. To compare effectiveness and safety of warfarin, dabigatran, and clopidogrel therapy as thromboembolism (TE) prevention strategy across the age groups in patients with nonvalvular atrial fibrillation (AF).
Material and methods. The study included 189 patients (110 men and 79 women), aged 65–80 years, with nonvalvular AF. All participants were divided into two groups: Group I (n=126) included patients aged 65–74 years. They were administered warfarin (n=43), in the dose providing the INR levels of 2,0–3,0; dabigatran (n=41) in the dose of 110 mg twice a day; and clopidogrel (n=42) in the dose of 75 mg/d. Group II (n=63) included patients aged 75–80 years. They were administered warfarin (n=22), dabigatran (n=20), and clopidogrel (n=21) in identical doses.
Results. In the younger age group, the 6-month treatment with dabigatran (110 mg twice a day), compared to the warfarin treatment, was associated with a similar incidence of ischemic stroke, but a lower risk of major bleeding (4,8% vs. 27,9%; p<0,05). The treatment with clopidogrel prevented stroke as effectively as the therapy with warfarin or dabigatran, and was reasonably safe. In the older age group, there was no significant difference in the incidence of TE and hemorrhagic complications between dabigatran and warfarin groups.
Conclusion. While selecting the antithrombotic therapy strategy in 65–74-year-old patients with nonvalvular AF, dabigatran and clopidogrel could be regarded as an acceptable alternative to warfarin.
About the Authors
V. I. Shevelev
Krasnodar City Hospital No. 2
Russian Federation
tel.: (861) 222–98–62
Russian Federation
tel.: (861) 222–98–62
S. G. Kanorskyi
Kuban State Medical University, Krasnoda
Russian Federation
Russian Federation
References
1. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet 2006; 367: 1747–57.
2. Hart RG, Pears LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857–67.
3. Camm A, Kirchhof P, Lip GYH, et al. Guidelines for the Management of Patients with Atrial Fibrillation. The Task Force for the Management of Atrial Fibrillation of the Europian Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369–429.
4. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996; 348: 1329–39.
5. ACTIVE Investigators, Connolly SJ, Pogue J, Hart RG, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009; 360: 2066–78.
6. Marinigh R, Lip GYH, Fiotti N, et al. Age as a risk factor for stroke in atrisl fibrillation patients implications for thromboprophylaxis. JACC 2010; 56: 827–37.
7. Poli D, Antonucci E, Grifoni E, et al. Bleeding risk during oral anticoagulation in atrial fibrillation patients older than 80 years. JACC 2009; 54: 999–1002.
8. Hylek EM, Evans-Molina C, Shea C, et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 2007; 115: 2689–96.
9. Mant J, Hobbs FD, Fletcher K. BAFTA Investigators. Midland Research Practices Network (MidRec). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study. BAFTA): a randomised controlled trial. Lancet 2007; 370: 493–503.
10. Wann LS, Curtis AB, January CT, et al. ACCF/AHA/HRS. 2011 ACCF/AHA/ HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. JACC 2011; 57: 223–42.
11. Goldstein IB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2011; 42: 517–84.
12. Medi C, Hankey GJ, Freedman SB. Stroke risk and antithrombotic strategies in atrial fibrillation. Stroke 2010; 41: 2705–13.
13. Douketis JD, Arneklev K, Goldhaber SZ, et al. Comparison of bleeding in patients with nonvalvular atrial fibrillation treated with ximelagatran ore warfarin. Assessment of incidence, case-fatality rate, time course and sites of bleeding, risk factors for bleeding. Arch Intern Med 2006; 166: 853–9.
14. Lee WM, Larrey D, Olsson R, et al. Hepatic findings in long-term clinical trials of ximelagatran. Drug Safety 2005; 28: 351–70.
15. The AMADEUS investigators. Comparison of idraparinux with vitamin K antagonists for prevention of thromboembolism in patients with atriaj fibrillation: a randomised, open-label, non-inferiority trial. Lancet 2008; 371: 315–21.
16. Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011; 364: 806–17.
Review
For citations:
Shevelev V.I., Kanorskyi S.G. AGE AND EFFECTIVENESS AND SAFETY OF VARIOUS ANTITHROMBOTIC THERAPY VARIANTS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION. Cardiovascular Therapy and Prevention. 2013;12(1):46-53. (In Russ.) https://doi.org/10.15829/1728-8800-2013-1-46-53
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