Clinical interventions in aging
Cerebral Microbleeds, Anemia, and Estimated Net Benefit of DOACs versus Warfarin in Older Atrial Fibrillation: A Single-Center MRI-Selected Cohort
By Ma J, Hou C, Xu F and 3 others.
Abstract
Background
Randomized trials favor direct oral anticoagulants (DOACs) over warfarin for eligible atrial fibrillation (AF), but whether cerebral microbleeds (CMBs) and anemia identify older patients with narrower benefit-harm margins remain uncertain. We estimated 2-year net clinical benefit (NCB) overall and by CMB/anemia strata.
Methods
This single-center, MRI-selected prospective observational cohort included patients aged ≥65 years with non-valvular AF receiving a DOAC or warfarin. Follow-up began at susceptibility MRI; CMB presence (0 vs ≥1) was rated by two blinded raters, and anemia used World Health Organization hemoglobin thresholds. DOAC-warfarin associations were estimated using propensity-score overlap weighting and competing-risk models for ischemic stroke/systemic embolism (IS/SE) and intracranial hemorrhage (ICH). Two-year NCB was expressed as net events prevented per 1000 with bootstrap 95% confidence intervals (CIs).
