Benefits and Complications οf Using New Oral Anticoagulants (NOACS) in Elderly and Very El- derly Patients with Non-Valvular Atrial Fibrilla- tion. A Comparative Study.
DOI:
https://doi.org/10.60988/pj.v35i4.23Keywords:
Atrial fibrillation, NOACS, warfarin, thromboembolism, elderlyAbstract
Αtrial fibrillation (AF) is the most common arrhythmia, with an increased frequency of occurrence in older age groups. AF can cause thromboembolic events with ischemic strokes being the most common. Therefore, the role of anticoagulant therapy is central. Until a few years ago, vitamin K antagonists (VKAs) represented the most used anticoagulant drugs for the prevention of thromboembolic complications of AF. However, VKAs had many problems in use, mainly due to their narrow therapeutic range, as well as multiple drug and food interactions. The increased requirements for frequent monitoring and dose adjustments led to decreased compliance and underuse. In recent years, new oral anticoagulant drugs (NOACs) have been developed, which have radi- cally changed the management of patients with AF. NOACs include dabigatran, which is a direct thrombin inhibitor, and rivaroxaban, apixaban and edoxaban, which are direct inhibitors of factor Xa. Phase 3 studies, as well as subsequent analyses and real-world evaluations, have shown that NOACs are more effective in preventing stroke and systemic thrombosis in olders and are considered as the best choice for elderly (>65) and very elderly (>80) patients with AF, with clear clinical benefit against warfarin, while demonstrating at least an equivalent safety profile. There are of course several differences between them, with apixaban appearing as the drug with the best efficacy and safety profile in the elderly over 75 years of age. However, the choice of the most appropriate anticoagulant treatment should take into account the individual clinical profile of each patient, evaluating each time the benefits and risks of its use.
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