{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T23:53:23Z","timestamp":1781222003406,"version":"3.54.1"},"reference-count":20,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Daiichi Sankyo Europe GmbH, Munich, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Elderly patients are at high risk of both ischaemic and bleeding events, and the low body weight is considered a risk factor for major bleeding in atrial fibrillation (AF) patients on anticoagulation therapy. The aim of our study was to compare the safety and effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) versus well-controlled vitamin-K antagonists (VKA) therapy among AF patients aged &gt;75 years and with a body weight &lt;60 kg in a prospective registry setting. Methods: Data for this study were sourced from the Italian cohorts of PREFER in AF and PREFER in AF PROLONGATION registries. The occurrence of a composite of stroke, transient ischemic attack and systemic embolism (thromboembolic events) was the primary effectiveness endpoint. The occurrence of major bleeding was the primary safety endpoint. All-cause hospitalizations and all-cause death were the secondary endpoints. The net clinical benefit (NCB) was calculated in order to obtain an integrated assessment of the anti-thromboembolic and pro-haemorrhagic effects of NOACs vs. VKA. Results: Overall, 522 patients were included; 225 were on treatment with NOACs and 317 patients with VKA. The NOAC group more frequently featured a higher BMI and a higher prevalence of history of stroke\/TIA and insulin-requiring diabetes; conversely, heart failure and chronic liver disease were less frequent in the NAOC group. In the unmatched study population, 18 patients (3.6% in the NOAC vs. 3.2% in the VKA group, p = 0.79) experienced thromboembolic events; 19 patients (1.78% in the NOAC vs. 4.73% in the VKA group, p = 0.06) experienced major bleeding events; and 68 patients were hospitalized during the follow-up (9.3% vs. 14.8%, p = 0.06). After balancing for potential confounders by using the 1:1 propensity score matching technique, 426 patients (213 on NOAC and 213 on VKA) were selected. We found no significant differences in terms of thromboembolic events (3.76% vs. 4.69%, p = 0.63), major bleeding events (n: 1.88% vs. 4.22%, p = 0.15) and hospitalizations (9.9% vs. 16.9%, p = 0.06) between NOAC vs. VKA matched population. Based on these incidences, we found a positive net clinical benefit (+1.6) of NOACs vs. VKAs. Conclusions: These real-world data suggest the safety and effectiveness of using NOACs in elderly patients with low body weight.<\/jats:p>","DOI":"10.3390\/jcm11133751","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T01:48:38Z","timestamp":1656467318000},"page":"3751","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical Performance of Oral Anticoagulants in Elderly with Atrial Fibrillation and Low Body Weight: Insight into Italian Cohort of PREFER-AF and PREFER-AF Prolongation Registries"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9227-0360","authenticated-orcid":false,"given":"Vincenzo","family":"Russo","sequence":"first","affiliation":[{"name":"Cardiology Unit, Department of Translational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d-Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-7815","authenticated-orcid":false,"given":"Emilio","family":"Attena","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Translational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d-Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3948-4914","authenticated-orcid":false,"given":"Matteo","family":"Baroni","sequence":"additional","affiliation":[{"name":"Cardiologia 3\u2013A. De Gasperis Cardio Center, ASST GOM Niguarda Ca\u2019Granda, Piazza dell\u2019Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Trotta","sequence":"additional","affiliation":[{"name":"Medical Affairs Department, Daiichi Sankyo, 00142 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius Constantin","family":"Manu","sequence":"additional","affiliation":[{"name":"Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulus","family":"Kirchhof","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"De Caterina","sequence":"additional","affiliation":[{"name":"Chair of Cardiology, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.hrthm.2016.12.036","article-title":"Increased risk of major bleeding in underweight patients with atrial fibrillation who were prescribed non-vitamin K antagonist oral anticoagulants","volume":"14","author":"Park","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1007\/s00380-015-0765-y","article-title":"Body mass index is associated with prognosis in Japanese elderly patients with atrial fibrillation: An observational study from the outpatient clinic","volume":"31","author":"Yanagisawa","year":"2016","journal-title":"Heart Vessel."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1111\/jth.13701","article-title":"Association of body weight with efficacy and safety outcomes in phase III randomized controlled trials of direct oral anticoagulants: A systematic review and meta-analysis","volume":"15","author":"Boonyawat","year":"2017","journal-title":"J. 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