Atrial fibrillation (AF) is an important cause of preventable, disabling
stroke and is increasingly prevalent with advancing age. As life expectancies increase around the world, AF-related
stroke is a growing global public health concern. Most AF patients are elderly (≥75 years old) and increasing age is a consistent independent risk factor for AF-associated
stroke.
Warfarin anticoagulation is highly effective for
stroke prevention in AF patients, but is underutilized especially in the elderly. Although elderly patients are at increased risk of
hemorrhage with oral
anticoagulants, the benefit for
ischemic stroke reduction exceeds the risk of
hemorrhage for most elderly patients. Consequently, age alone should not be considered a
contraindication for anticoagulation. Novel oral
anticoagulants such as
dabigatran,
rivaroxaban and
apixaban are at least as effective as
warfarin in preventing
strokes in patients with AF. Relative to
warfarin, these novel agents reduce the risk of
intracranial hemorrhage, the most devastating complication of anticoagulation
therapy in elderly AF patients. The novel oral
anticoagulants are especially appealing for
stroke prevention in elderly patients with AF.