DOACs on par with VKAs in octogenarians with VTE

Direct oral anticoagulants (DOACs) are as effective and safe as vitamin K antagonists (VKAs) among octogenarians with venous thromboembolism (VTE), a study has shown.

This international cohort study was conducted using administrative healthcare databases from Canada and Germany. The authors gathered two population-based cohorts of octogenarians with incident VTE who initiated treatment with DOACs or VKAs. The study began in January 2022 and ended on the most recent data of data availability (Canada: December 2016; Germany: December 2019).

The authors compared the use of DOACs to that of VKAs using an as-treated exposure definition, applying inverse probability of treatment weighting based on high-dimensional propensity scores to balance exposure groups.

Cox proportional hazards models were also used to estimate site-specific hazard ratios (HRs) and 95 percent confidence intervals (CIs) of recurrent VTE, major bleeding, and all-cause mortality. Random-effects models were then used to meta-analyse the results.

A total of 6,737 octogenarians with VTE (Canada: n=2,556; Germany: n=4,181) who initiated DOACs (n=3,778) or VKAs (n=2,959) were included in the analysis.

Use of DOACs, when compared to VKAs, correlated with similar risks of recurrent VTE (weighted HR, 0.80, 95 percent CI, 0.43‒1.46; I², 0.00), major bleeding (weighted HR, 0.96, 95 percent CI, 0.57‒1.63; I², 0.59), and all-cause mortality (weighted HR, 1.04, 95 percent CI, 0.81‒1.34; I², 0.00).

“Our results support the use of DOACs in this high-risk group,” the authors said.