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Citation
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Rao MP, Vinereanu D, Wojdyla DM, Alexander JH, Atar D, Hylek EM, Hanna M, Wallentin L, Lopes RD, Gersh BJ, Granger CB. Am. J. Med. 2018; 131(3): 269-275.e2. |
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Abstract
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PURPOSE: We assessed outcomes among anticoagulated patients with atrial fibrillation (AF) and a history of falling, and whether the benefits of apixaban versus warfarin are consistent in this population.
METHODS: Of the 18,201 patients in ARISTOTLE, 16,491 had information about history of falling - 753 with history of falling and 15,738 without history of falling. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding.
RESULTS: When compared with patients without a history of falling, patients with a history of falling were older, more likely to be female and have dementia, cerebrovascular disease, depression, diabetes, heart failure, osteoporosis, fractures, and higher CHA2DS2-VASc and HAS-BLED scores. Patients with a history of falling had higher rates of major bleeding (adjusted HR 1.39; 95% CI 1.05-1.84; p=0.020), including intracranial bleeding (adjusted HR 1.87, 95% CI 1.02-3.43; p=0.044), and death (adjusted HR 1.70; 95% CI 1.36-2.14; p<0.0001), but similar rates of stroke or systemic embolism and hemorrhagic stroke. There was no evidence of a differential effect of apixaban compared with warfarin on any outcome, regardless of history of falling. Among those with a history of falling, subdural bleeding occurred in 5 of 367 patients treated with warfarin and 0 of 386 treated with apixaban.
CONCLUSIONS: Patients with AF and a history of falling receiving anticoagulation have a higher risk of major bleeding, including intracranial, and death. The efficacy and safety of apixaban compared with warfarin were consistent, irrespective of history of falling.
Copyright © 2017. Published by Elsevier Inc.
Language: en |