Faculty Opinions recommendation of Frailty and clinical outcomes of direct oral anticoagulants versus warfarin in older adults with atrial fibrillation : A cohort study.

Background Evidence for direct oral anticoagulants (DOACs) in patients with cirrhosis is limited. Few patients with Child-Turcotte-Pugh (CTP) class B and C cirrhosis have been studied. Objective To compare major bleeding rates in patients with cirrhosis receiving a DOAC versus warfarin. Methods A retrospective cohort study was conducted in adults with cirrhosis receiving a DOAC versus warfarin for venous thromboembolism, portal-vein thrombosis, or atrial fibrillation. The primary outcome was the rate of major bleeding. Secondary outcomes included time to major bleeding, clinically relevant nonmajor bleeding, all bleeding, gastrointestinal bleeding, intracranial bleeding, and new thromboembolic events. The study was approved by the Ochsner Health System Institutional Review Board. Results A total of 44 patients receiving a DOAC and 41 patients receiving warfarin were included. Major bleeding occurred in 4 patients receiving a DOAC and 6 patients receiving warfarin (9.1% vs 14.6%; P = 0.881). Rates of major bleeding were similar in 24 DOAC and 17 warfarin patients with CTP Class B (4.2% vs 17.6%; P = 0.37) and 8 DOAC and 9 warfarin patients with CTP Class C (37.5% vs 11.1%; P = 0.41) cirrhosis. Secondary bleeding and efficacy outcomes were similar between cohorts. The study was limited by a small sample size. Conclusion and Relevance Treatment with DOACs in patients with cirrhosis was associated with a similar rate of major bleeding compared with warfarin. Inclusion of CTP class C patients in future studies remains valuable to evaluate safety and efficacy of DOACs in this population.

Download Full-text

Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation: protocol for a multicentre, prospective, observational, longitudinal cohort study (Strawberry study)

BMJ Open ◽

10.1136/bmjopen-2018-021759 ◽

2018 ◽

Vol 8 (11) ◽

pp. e021759 ◽

Cited By ~ 2

Author(s):

Naoki Saji ◽

Takashi Sakurai ◽

Kengo Ito ◽

Hidekazu Tomimoto ◽

Kazuo Kitagawa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Cognitive Impairment ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Brain Mri ◽

Cerebrovascular Diseases ◽

Longitudinal Cohort Study ◽

Protective Effects ◽

Longitudinal Cohort

IntroductionNon-valvular atrial fibrillation (NVAF) is known as a robust risk factor for stroke. Recent reports have suggested a risk of dementia with NVAF, but much remains unknown regarding the relationship between this mechanism and the potential protective effects of novel anticoagulants (direct oral anticoagulants (DOACs), or non-vitamin K oral anticoagulants).Methods and analysisThis study, the strategy to obtain warfarin or DOAC’s benefit by evaluating registry, is an investigator-initiated, multicentre, prospective, observational, longitudinal cohort study comparing the effects of warfarin therapy and DOACs on cerebrovascular diseases and cognitive impairment over an estimated duration of 36 months. Once a year for 3 years, the activities of daily living and cognitive functioning of non-demented patients with NVAF will be assessed. Demographics, risk factors, laboratory investigations, lifestyle, social background and brain MRI will be assessed.Ethics and disseminationThis protocol has been approved by the ethics committee of the National Center for Geriatrics and Gerontology (No. 1017) and complies with the Declaration of Helsinki. Informed consent will be obtained before study enrolment and only coded data will be stored in a secured database. The results will be published in peer-reviewed journals and presented at scientific meetings to ensure the applicability of the findings in clinical practice.Trial registration numberUMIN000025721.

Download Full-text