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Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis Bonanad, Clara García Blas, Sergio Torres Llergo, Javier Fernández Olmo, Rosa Díez Villanueva, Pablo Ariza Solé, Albert Martínez Sellés, Manuel Raposeiras Roubín, Sergio Ayesta, Ana Bertomeu González, Vicente Tarazona Santabalbina, Francisco Facila, Lorenzo Vivas, David Gabaldón Pérez, Ana Bodi, Vicente Nuñez, Julio Cordero, Alberto Persones grans Malalties coronàries Anticoagulants (Medicina) Infart de miocardi Older people Coronary diseases Anticoagulants (Medicine) Myocardial infarction Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63-0.82; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70-0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69-1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76-1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36-0.60; p < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF. 2022-03-08T07:42:33Z 2022-03-08T07:42:33Z 2021-11-12 2022-03-08T07:42:34Z info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Reproducció del document publicat a: https://doi.org/10.3390/jcm10225268 Journal of Clinical Medicine, 2021, vol. 10, num. 22, p. 5268 https://doi.org/10.3390/jcm10225268 cc-by (c) Bonanad, Clara et al., 2021 https://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess MDPI Articles publicats en revistes (Ciències Clíniques)