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Direct Oral Anticoagulants in Octogenarians With Atrial Fibrillation

It Is Never Too Late

Russo, Vincenzo, MD, PhD; Carbone, Andreina, MD; Rago, Anna, MD; Golino, Paolo, MD; Nigro, Gerardo, MD

Journal of Cardiovascular Pharmacology: April 2019 - Volume 73 - Issue 4 - p 207–214
doi: 10.1097/FJC.0000000000000661
Review Article

Abstract: Atrial fibrillation is the most common arrhythmia in clinical practice, and age is one of the strongest predictors/risk factors for ischemic stroke in patients with atrial fibrillation. Elderly patients, in particular patients aged 80 years and older, are at higher risk of both ischemic and bleeding events compared with younger patients. Vitamin K antagonists (VKAs) reduce the risk of ischemic stroke, especially in the elderly, but increase the bleeding risk. In addition, frequent international normalized ratio monitoring is needed to ensure the optimal level of anticoagulation. Furthermore, VKAs have multiple drug and food interactions. Direct oral anticoagulants (DOACs) have recently emerged as alternatives to VKAs and are gradually increasing their popularity mainly because of their fewer drug and food interactions and ease of use. Their effectiveness and safety have been well-established in the general population, but the benefit in the very elderly (≥80 years old) is still unclear. Data about the safety and the effectiveness of DOACs in patients older than 75 years are available in literature, but the evidences of the use of DOACs in patients aged 80 years and older are lacking. This review aims to give light to the differences, in terms of benefits and safety, of the DOACs in this subset of patients.

University of Campania “Luigi Vanvitelli,” Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy.

Reprints: Vincenzo Russo, MD, PhD, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, AORN dei Colli, via Leonardo Bianchi 1, Napoli 80131 (e-mail:

The authors report no conflicts of interest.

V. Russo and A. Carbone designed the research, performed research, and wrote the article; A. Rago, P. Golino, and G. Nigro reviewed the article.

Received September 06, 2018

Accepted January 16, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.