Using blood thinners to prevent stroke in very elderly patients with atrial fibrillation is a challenge for doctors, because of an increased risk of bleeding.
Researchers from the Saiseikai Kumamoto Hospital in Japan decided to conduct a randomised, double-blind trial to compare a daily dose of blood thinner edoxaban with a placebo treatment involving almost 700 elderly Japanese patients who were 80 years old and above.
They all had atrial fibrillation, and weren’t considered to be appropriate candidates for oral blood-thinning therapy at doses approved for stroke prevention.
The annual rate of stroke or systemic embolism was 2.3 per cent in the edoxaban group and 6.7 per cent in the placebo group, and the annualised rate of major bleeding was 3.3 per cent in the edoxaban group and 1.8 per cent in the placebo group.
There were substantially more events of gastrointestinal bleeding in the edoxaban group than in the placebo group.
There was no substantial between-group difference in death from any cause.
The researchers concluded that, in very elderly Japanese patients with nonvalvular atrial fibrillation who were not appropriate candidates for standard doses of oral anticoagulants, a once-daily 15-mg dose of edoxaban was superior to placebo in preventing stroke or systemic embolism and did not result in a significantly higher incidence of major bleeding than placebo.
