Patients aged 90 years or older with atrial fibrillation treated with oral anticoagulants: A multicentre observational study.

Abstract

BACKGROUND:

Patients aged 90 years or older are often excluded from or under-represented in clinical trials and cohort studies. The clinical benefit of anticoagulation in nonagenarians with atrial fibrillation (AF) remains undefined.

OBJECTIVES:

To assess the effectiveness and safety of oral anticoagulants in AF patients aged 90 years or older.

METHODS:

Non-valvular AF patients aged 90 years or older receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) were included in this observational multicentre study. The primary outcome was the composite of ischaemic stroke/transient ischemic attack (TIA) and systemic embolism (SE). Major bleeding (MB), anticoagulant discontinuation and all-cause death were also assessed. Results are reported as sub-distribution hazard ratios (SHR) with 95% CI, taking death as competing risk.

RESULTS:

546 patients were included (301 VKAs retrospective cohort and 245 DOACs prospective cohort; median follow-up 404 days). The rate of ischaemic stroke/TIA/SE was 2.4% patient-year and that of MB 5.5% patient-year. Previous ischaemic stroke/TIA (SHR 3.47; 95% CI 1.54-7.81) and vascular disease (SHR 2.89; 95% CI 1.27-6.60) were independent predictors of ischaemic stroke/TIA/SE. Previous bleeding (SHR 2.53; 95% CI 1.37-4.64) was an independent predictor of MB. The risk of ischaemic stroke/TIA/SE (SHR 0.78, 95% CI 0.30-2.04) or MB (SHR 1.43, 95% CI 0.77-2.65) was not significantly different with DOACs or VKAs.

CONCLUSIONS:

In AF nonagenarians receiving anticoagulant treatment, the rate of ischaemic stroke/TIA/SE is relatively low with the drawback of a not negligible rate of MB. DOACs seem a reasonable option for prevention of ischaemic stroke/TIA/SE in this setting.

• Authors: Michela Giustozzi, Maria Cristina Vedovati, Melina Verso, Luca Scrucca, Serenella Conti, Paolo Verdecchia, Giulio Bogliari, Lucia Pierpaoli, Giancarlo Agnelli, Cecilia Becattini
• Journal: International journal of cardiology (Int J Cardiol) Vol. 281 Pg. 56-61 (Apr 15 2019) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 30712846 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anticoagulants

Topics

• Administration, Oral
• Age Factors
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Atrial Fibrillation (diagnosis, diagnostic imaging, drug therapy, physiopathology)
• Cohort Studies
• Female
• Follow-Up Studies
• Hemorrhage (chemically induced)
• Humans
• Ischemic Attack, Transient (diagnosis, physiopathology, prevention & control)
• Male
• Prospective Studies
• Treatment Outcome