PB0496 - Management of non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation in Spain. RE-BELD study

Background: Older age is an important risk factor for patients with atrial fibrillation (AF) and is associated with an increased risk of stroke and systemic embolism, as well as an increased risk of severe bleeding with oral anticoagulant therapy. The use of non-vitamin K antagonist oral anticoagulants (NOACs) in the elderly population in routine clinical practice shows deficiencies and can be improved, with incorrect dosing being common in this population.

Aims: The main objective of the study was to describe the pattern of NOAC use in elderly patients with AF.

Methods: A national, non-interventional, cross-sectional and multicenter study was designed. Elderly (≥75 years) patients, with a AF diagnosis and undergoing NOAC treatment according to the SmPC at least 3 months before the study visit were recruited

Results: 503 patients were recruited (500 eligible, 3 excluded) in 36 Hematology, Cardiology and Geriatrics centers. The mean (±SD) age was 81.5 (±4.7) years, 50% women, mean time of AF diagnosis 5.5 (±5.3) years, 47.0% permanent AF, mean creatinine clearance of 57.3 (±18.9) ml/min, CHA2DS2-VASc =4.33 (±1.36) and HASBLED =1.96 (±0.87). The prevalence of frailty, calculated using the clinical frailty scale (CFS> 4), was observed in 23.6% of the patients.
Regarding oral anticoagulant (OAC) treatment, 57.4% of the patients were previously treated with VKAs. Of the 500 evaluable patients, 38.4% were treated with dabigatran, 15.2% with rivaroxaban, 33.2% with apixaban, and 13.2% with edoxaban. 8.6% of the patients have a NOAC switch and 3.6% receive antiplatelets concomitantly. Figure 1 shows the NOAC dosage patterns.
A 48.4% and 88.6% of thromboembolic and bleeding events occurred after the start of anticoagulant treatment. Table 1 shows the thromboembolic and bleeding events associated to ACO treatment.

Conclusion(s): It is essential to develop effective strategies to improve the correct dosage of OAC treatment in elderly patients at usual clinical practice.