[Risk of hemorrhage in patients older than 85 years, anticoagulated due to atrial fibrillation]
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Updated: May 21, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Jose I Revigliono1, Tomas Amuchastegui, Alejandro E Contreras
1Servicio de Clínica Médica1 y Cardiología2, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina.
Insights
Patients over 85 with nonvalvular atrial fibrillation on warfarin have a significantly higher risk of major bleeding events. Careful monitoring is crucial for this elderly population to mitigate bleeding risks.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Context:
- Atrial fibrillation is a common arrhythmia and a major risk factor for stroke and hemorrhage.
- Hemorrhagic risk increases with age, particularly after 40.
- Warfarin is a common anticoagulant for atrial fibrillation patients.
Purpose:
- To compare the annual rate of hemorrhagic events in nonvalvular atrial fibrillation patients treated with warfarin, stratified by age (older vs. younger than 85 years).
Summary:
- A retrospective study of 118 nonvalvular atrial fibrillation patients on warfarin found that those over 85 experienced a significantly higher rate of major bleeding (4.62%/year) compared to younger patients (0.95%/year).
- No significant difference in minor bleeding rates or Time in Therapeutic Range was observed between the age groups.
- The study highlights an increased risk of major bleeding in elderly patients over 85.
Impact:
- Age should not preclude anticoagulation therapy for atrial fibrillation.
- Elderly patients (over 85) require heightened vigilance and careful monitoring due to their elevated risk of bleeding.
- Findings inform clinical practice regarding anticoagulation management in older adults with atrial fibrillation.
Background:
Atrial fibrillation is the most common cardiac tachyarrhythmia and is an important independent risk factor for ischemic stroke. Its prevalence begins to increase in both sexes after 40 years of age as well as the risk of hemorrhage. The aim of this study was to compare the annual rate of hemorrhagic events between patients older and younger than 85 years, with diagnosis of nonvalvular atrial fibrillation and anticoagulated with warfarin.
Material And Methods:
A retrospective study was performed. We included 118 patients with diagnosis of nonvalvular atrial fibrillation monitorized by an informatized follow up system.
Results:
The study follow-up was 28,2 ± 17,5 months and 24 patients (20,3%) were older than 85 years of age. The rate of major bleedings was 4,62%/year (older than 85 years) vs 0,95%/year (younger than 85 years) , p= 0,05, OR 6,57 (IC 95% 1,04-41,8) and minor bleeding was 4,62%/year (older than 85 years) vs 5,2%/year (younger than 85 years), p=0,99, OR 1,08 (IC 95% 0,28-4,21). There was no difference in the Time in Therapeutic Range between both groups (56.4 ± 16.3 % vs 60.5 ± 17.7 %, p 0,30).
Conclusion:
The age should not be considered a contraindication to anticoagulant therapy, however, special care and careful monitoring of patients older than 85 years should be considered due to they had high risk of bleeding.
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