Survenue d’évènements hémorragiques chez les personnes âgées sous nouveaux anticoagulants oraux directs et anti-vitamine K lors d’une hospitalisation et leur suivi en médecine ambulatoire

Abstract : Background: direct-acting oral anticoagulant (DOAC) are known to be effective in patients with non valvular atrial fibrillation (NVAF) but few data on tolerance in elderly have been published. Objective: compare after one year the risk of bleeding between hospitalized elderly patients with NVAF, receiving DOAC vs vitamin K antagonists (VAK). Methods: observational study of elderly (>75 years old), hospitalized patients with NAVF, included between January 2013 and June 2014. Follow-up data on bleeding or death were obtained by phone calls with the General Practitioner. Risk factors of haemorrhages where estimated using a logistic regression. Results: four hundred and forty one patients (71% were female) were included (300 VAK and 151 DOAC users). Mean age was respectively 87.1 (sd 5.4) and 85.7 (sd 5.1) years. MMSE was 19.1 (sd 7.2), HASBLED score was 2.3 (sd 0.9). Cockcroft’s creatinine clearance was 48.8 (sd 22.1) ml/min, albumin was 31.4 (sd 5) g/l. One hundred and three bleedings outcomes were found, with a lower bleeding tendency for DOAC (19.9%) vs VAK (24.3%), p=0.06. Risk factors of bleeding withVKA were major anterior bleeding (OR 5.36 (95% CI, 1.69-16.98)), creatinine clearance <40ml/min (OR: 2.30 (95% CI, 1.13-4.68)) and hypoalbuminemia (OR: 2.03 [95% CI, 1.06-3.90]). Risk factors of bleeding with DOAC was a lower platelets rate < 250 000/mm3 (OR: 2.69 [95% CI, 1.06-6.85]). Death rate was significantly lower with DOAC (21.8%) than with VAK (33.3%), p=0.005. Conclusion: in common practice within elderly patients, DOAC are well tolerated in comparison with VAK.
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Anne-Claire Cadhilac. Survenue d’évènements hémorragiques chez les personnes âgées sous nouveaux anticoagulants oraux directs et anti-vitamine K lors d’une hospitalisation et leur suivi en médecine ambulatoire. Médecine humaine et pathologie. 2016. ⟨dumas-01646097⟩

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