Edoxaban matches apixaban for stroke prevention in very elderly population

Very elderly patients with nonvalvular atrial fibrillation fare well with either edoxaban or apixaban in terms of stroke prevention, although those on edoxaban may have higher bleeding risk, according to a study.

For the study, researchers used data from the United Kingdom Clinical Practice Research Datalink and identified 47,242 patients with incident nonvalvular atrial fibrillation in the ≥80-year age group. Of the patients, 7,251 were new users of edoxaban and 39,991 were new users of apixaban.

The primary effectiveness outcome was any ischaemic stroke, transient ischaemic attack, or systemic embolism events. The primary safety outcome was major bleeding. Secondary outcomes included all-cause mortality and a composite outcome of ischaemic stroke or transient ischaemic attack, systemic embolism, gastrointestinal bleeding, and intracranial haemorrhage. These outcomes were compared between the edoxaban and apixaban groups using propensity score fine stratification and weighting.

The incidence of thromboembolism did not significantly differ between the edoxaban group and the apixaban group (adjusted rates, 20.38 vs 19.22 per 1,000 person-years; adjusted hazard ratio [HR], 1.06; 95 percent confidence interval [CI], 0.89–1.26).

However, major bleeding occurred with greater frequency in the edoxaban group (adjusted rates, 45.57 vs 31.21 per 1,000 person-years; adjusted HR, 1.42; 95 percent CI, 1.26–1.61).

Edoxaban was also associated with a higher risk of the composite outcome (adjusted HR, 1.21; 95 percent CI, 1.07–1.38). All-cause mortality did not significantly differ between edoxaban and apixaban (adjusted HR, 1.04; 95 percent CI, 0.96–1.12).

The present data may inform the management of nonvalvular atrial fibrillation the very elderly population, according to the researchers.