Optimal antithrombotic treatment of older patients is usually impeded by several prevailing misconceptions. The aim of our study was to assess the type, dosage and predictors of antithrombotic
therapy in older patients with non-valvular
atrial fibrillation (NVAF). PAVE-AF was a prospective, cross-sectional study, including NVAF patients ≥ 80 years from 30 participating centers. Demographic data, comorbidities and treatment patterns were documented in a single visit. Patients treated with non-
vitamin K oral
anticoagulants (NOACs) were further classified into three dosing categories (recommended, underdosing and overdosing). Among 1018 patients (85.4±4.0 years), 88.4% received
anticoagulants (AC), 8% antiplatelets (AP) and 3.6% no treatment. The primary reason for AP administration was physician concern of
bleeding followed by patient denial. Patients ≥90 years had two times greater probability to receive AP
therapy compared to patients < 90 years. Among patients treated with AC, one third received
vitamin K antagonists, while two thirds received NOACs [34.6%
apixaban, 9.5%
dabigatran and 22.6%
rivaroxaban]. Independent predictors of AC prescription over AP or no treatment were low HAS-BLED score,
hypertension, labile INR, permanent AF, absence of uncontrolled
hypertension, prior
stroke/systemic
embolism, age and male gender. In total, 37% of
NOAC recipients received inappropriate dosage, while the number of patients receiving recommended dosing differed significantly among
NOAC subgroups (p < 0.001). In our study, a minority of older NVAF patients received AP or no
therapy for
stroke prevention. Among patients treated with
anticoagulants, two thirds were on
NOAC treatment, though with a considerable proportion of inappropriate dosing.