@article{01GW4ZGKN554XGCP69ZFRR602A,
  abstract     = {{Data on non-vitamin K antagonist oral anticoagulants (NOACs) use in patients with atrial fibrillation (AF) and frailty are scarce. Therefore, the impact of frailty on AF-related outcomes and benefit-risk profiles of NOACs in patients with frailty were investigated.
Methods and results: AF patients initiating anticoagulation between 2013–2019 were included using Belgian nationwide data. Frailty was assessed with the Claims-based Frailty Indicator. Among 254 478 anticoagulated AF patients, 71 638 (28.2%) had frailty. Frailty was associated with higher all-cause mortality risks (adjusted hazard ratio (aHR) 1.48, 95% confidence interval (CI) (1.43–1.54)), but not with thromboembolism or bleeding. Among subjects with frailty (78 080 person-years of follow-up), NOACs were associated with lower risks of stroke or systemic embolism (stroke/SE) (aHR 0.77, 95%CI (0.70–0.86)), all-cause mortality (aHR 0.88, 95%CI (0.84–0.92)) and intracranial bleeding (aHR 0.78, 95%CI (0.66–0.91)), a similar major bleeding risk (aHR 1.01, 95%CI (0.93–1.09)) and higher gastrointestinal bleeding risk (aHR 1.19, 95%CI (1.06–1.33) compared to VKAs. Major bleeding risks were lower with apixaban (aHR 0.84, 95%CI (0.76–0.93)), similar with edoxaban (aHR 0.91, 95%CI (0.73–1.14)), and higher with dabigatran (aHR 1.16, 95%CI (1.03–1.30)) and rivaroxaban (aHR 1.11, 95%CI (1.02–1.21)) compared to VKAs. Apixaban was associated with lower major bleeding risks compared to dabigatran (aHR 0.72, 95%CI (0.65–0.80)), rivaroxaban (aHR 0.78, 95%CI (0.72–0.84)) and edoxaban (aHR 0.74, 95%CI (0.65–0.84)), but mortality risk was higher compared to dabigatran and edoxaban. 
Conclusion: Frailty was an independent risk factor of death. NOACs had better benefit-risk profiles than VKAs in patients with frailty, especially apixaban, followed by edoxaban.}},
  author       = {{Grymonprez, Maxim and Petrovic, Mirko and De Backer, Tine and Steurbaut, Stephane and Lahousse, Lies}},
  issn         = {{2058-5225}},
  journal      = {{EUROPEAN HEART JOURNAL-QUALITY OF CARE AND CLINICAL OUTCOMES}},
  keywords     = {{Anticoagulan,Atrial fibrillation,Bleeding,Death,Frailty,Thromboembolism}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{55--65}},
  publisher    = {{Oxford University Press (OUP)}},
  title        = {{Impact of frailty on the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation : a nationwide cohort study}},
  url          = {{http://doi.org/10.1093/ehjqcco/qcad019}},
  volume       = {{10}},
  year         = {{2024}},
}

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