Debbie Rigby takes a look at the latest in research news 

Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation

A systematic review and meta-regression analysis of 26 studies has shown warfarin use is superior to warfarin non-use, aspirin and no antithrombotic therapy in reducing the risk of stroke/TE in older people with atrial fibrillation, but with a possible increase in major bleeding. DOACs are superior to warfarin for stroke/TE prevention, with reduced risk of major bleeding.

Age Ageing 2018;47(1):9-17.

 

Effect of New Oral Anticoagulants on Prescribing Practices for Atrial Fibrillation in Older Adults

This retrospective observational cohort study of 6,568 people with atrial fibrillation aged 75 years and older shows increased NOAC use over 5 years, with no change in warfarin in warfarin usage. Overall, fewer than 45% of participants were prescribed an anticoagulant; with consistently lower use in people aged 90 and older. A number of factors increased the likelihood of being prescribed NOACs, including younger age, white race, female sex, higher haemoglobin, higher creatinine clearance, hypertension, stroke or transient ischemic attack, no history of intracranial haemorrhage, and a modified HAS-BLED score of less than 3.

J Am Geriatr Soc. 2017;65(11):2405-2412.

 

Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults

In this systematic review and meta-analysis of 33 randomised clinical trials (n=51,145), the use of supplements that included calcium, vitamin D, or both was not associated with a significant difference in the risk of hip fractures compared with placebo or no treatment. The authors conclude that these findings do not support the routine use of these supplements in community-dwelling older adults.

JAMA. 2017;318(24):2466-2482.

Medscape summary

 

Vitamin D Supplementation During Pregnancy

In this systematic review and meta-analysis of 43 randomised clinical trials (n=8406), there was strong evidence that prenatal vitamin D reduced the risk of offspring wheeze by age 3 years. For most other outcomes including hypertensive diseases of pregnancy, gestational diabetes, maternal and neonatal morbidity, and infant developmental outcomes, the evidence was inconclusive.

BMJ. 2017;359(j5237).