New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials

Abstract

Objectives: To evaluate the efficacy and safety of new oral anticoagulants (NOACs) in elderly adults.

Design: Meta-analyses of randomized clinical trials (RCTs).

Setting: PubMed, Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched from January 1, 2001, through March 30, 2013.

Participants: Elderly population (≥ 75) in RCTs comparing NOACs (rivaroxaban, apixaban, and dabigatran) with conventional therapy.

Measurements: Two authors reviewed the trials, and odds ratios (ORs) were calculated using a random effects model.

Results: Ten RCTs included 25,031 elderly participants. Risk of major or clinically relevant bleeding was not significantly different between NOACs and conventional therapy in elderly adults (OR = 1.02, 95% confidence interval = 0.73-1.43). Similar results were observed when comparing NOACs and pharmacologically active agents. In atrial fibrillation (AF) trials, NOACs were more effective than conventional therapy in prevention of stroke or systemic embolism in an elderly population with AF. In non-AF trials, NOACs also had a significantly lower risk of venous thromboembolism (VTE) or VTE-related death than conventional therapy in elderly adults. Analysis for individual NOACs showed that the NOAC was noninferior or more effective than conventional therapy for efficacy and safety outcomes.

Conclusion: In participants of clinical trials aged 75 and older, NOACs did not cause excess bleeding and were associated with equal or greater efficacy than conventional therapy.

Keywords: elderly; meta-analysis; new anticoagulants.