Front Pharmacol. 2026 May 12;17:1756880. doi: 10.3389/fphar.2026.1756880. eCollection 2026.
ABSTRACT
BACKGROUND: The optimal anticoagulation strategy for stroke prevention in very elderly patients (≥80 years) with non-valvular atrial fibrillation (NVAF) remains challenging due to the high risks of both thromboembolism and bleeding. This study aimed to evaluate the effectiveness and safety of low-dose rivaroxaban (10 mg) in this specific population.
METHODS: This single-center, real-world cohort study enrolled 1,005 patients aged ≥80 years with NVAF between January 2021 and December 2023. Patients were categorized into three groups based on their antithrombotic regimen: a non-anticoagulation group (n = 177), a low-dose rivaroxaban group (10 mg, n = 168), and a conventional anticoagulation group (n = 660). The primary efficacy outcome was stroke, and the primary safety outcome was major bleeding. Outcomes were analyzed using multivariable Cox regression models and competing risk models to account for death as a competing event where appropriate.
RESULTS: Compared with no anticoagulation, low-dose rivaroxaban was associated with significantly lower risks of stroke (hazard ratio (HR) 0.20, 95% confidence interval (CI) 0.05-0.78; P = 0.0201), all-cause mortality (HR 0.28, 95% CI 0.13-0.60; P = 0.0012), and cardiac death (HR 0.31, 95% CI 0.17-0.81; P = 0.0170), with efficacy comparable to conventional anticoagulation. Direct comparison showed no significant differences in efficacy outcomes between the low-dose and conventional anticoagulation groups. Moreover, the risk of major bleeding was numerically lower with low-dose rivaroxaban than with conventional anticoagulation (HR 2.01 for conventional vs. low-dose, 95% CI 0.93-4.12; P = 0.0856).
CONCLUSION: In very elderly patients (≥80 years) with NVAF, low-dose rivaroxaban (10 mg) was associated with similar effectiveness to conventional anticoagulation in preventing stroke and reducing mortality, while showing a potential safety advantage with a numerically lower risk of major bleeding. These findings support the use of low-dose rivaroxaban as a favorable individualized antithrombotic strategy for this vulnerable population.
PMID:42206170 | PMC:PMC13201401 | DOI:10.3389/fphar.2026.1756880