AGE AND EFFECTIVENESS AND SAFETY OF VARIOUS ANTITHROMBOTIC THERAPY VARIANTS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION

Abstract

Aim. To compare effectiveness and safety of warfarin, dabigatran, and clopidogrel therapy as thromboembolism (TE) prevention strategy across the age groups in patients with nonvalvular atrial fibrillation (AF).Material and methods. The study included 189 patients (110 men and 79 women), aged 65–80 years, with nonvalvular AF. All participants were divided into two groups: Group I (n=126) included patients aged 65–74 years. They were administered warfarin (n=43), in the dose providing the INR levels of 2,0–3,0; dabigatran (n=41) in the dose of 110 mg twice a day; and clopidogrel (n=42) in the dose of 75 mg/d. Group II (n=63) included patients aged 75–80 years. They were administered warfarin (n=22), dabigatran (n=20), and clopidogrel (n=21) in identical doses.Results. In the younger age group, the 6-month treatment with dabigatran (110 mg twice a day), compared to the warfarin treatment, was associated with a similar incidence of ischemic stroke, but a lower risk of major bleeding (4,8% vs. 27,9%; p<0,05). The treatment with clopidogrel prevented stroke as effectively as the therapy with warfarin or dabigatran, and was reasonably safe. In the older age group, there was no significant difference in the incidence of TE and hemorrhagic complications between dabigatran and warfarin groups.Conclusion. While selecting the antithrombotic therapy strategy in 65–74-year-old patients with nonvalvular AF, dabigatran and clopidogrel could be regarded as an acceptable alternative to warfarin.

Keywords

• atrial fibrillation
• ischemic stroke
• antithrombotic therapy
• elderly age