Comparison of Real-World Effectiveness and Safety of Dabigatran in Geriatric Patients with Atrial Fibrillation and Those Younger than 60 Years Old at Multicenter in Thailand
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Abstract
Objective: To compare the effectiveness and safety of dabigatran between geriatric (60 years old or older) and younger patients with atrial fibrillation (AF) and to study the risk factors of ischemic stroke and bleeding in geriatric patients treated with dabigatran. Methods: This was a real-world retrospective study in non-valvular AF patients treated with dabigatran in two hospitals including Phramongkutklao Hospital and Taksin Hospital. A total of 484 patients included 413 geriatrics patients (85.33%) and 71 younger patients (14.77%). The median of the follow-up period was 1.88 (interquartile range: 0.75-2.00) years. Results: Geriatric patients with dabigatran use had a higher incidence of ischemic stroke than younger patients did (3.97%, 0%, respectively; P <0.001). Geriatric patients also had a higher bleeding incidence than younger patients did (18.36%, 8.29% respectively; P = 0.041). The significantly higher incidences were found in major bleeding, minor bleeding and gastrointestinal bleeding (P = 0.035, P = 0.015 and P <0.001, respectively). On multivariate analysis, prior stroke or systemic embolism was a risk factor for recurrent stroke in geriatric patients with dabigatran use [odds ratio (OR) = 11.00, 95% CI 2.09-58.02, P = 0.005], while prior bleeding was a risk factor for bleeding in geriatric patients with dabigatran use (OR = 3.46, 95% CI 2.00-6.00, P <0.001). Conclusion: In geriatric patients with dabigatran use for preventing ischemic stroke from AF should be monitored for ischemic stroke and bleeding, especially geriatric patients with history of stroke or systemic embolism and bleeding.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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