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

Michela Giustozzi1, Maria Cristina Vedovati1, Melina Verso1

  • 1Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.

International Journal of Cardiology
|February 5, 2019
PubMed

Insights

Anticoagulant treatment in nonagenarians with atrial fibrillation (AF) shows a low rate of stroke and systemic embolism but a notable risk of major bleeding. Direct oral anticoagulants (DOACs) appear to be a reasonable choice for stroke prevention in this elderly population.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Nonagenarians (aged 90+) with atrial fibrillation (AF) are underrepresented in clinical studies.
  • The efficacy and safety of anticoagulation in this population are not well-defined.

Purpose of the Study:

  • To evaluate the effectiveness and safety of oral anticoagulants in patients aged 90 years or older with AF.
  • To compare direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in this demographic.

Main Methods:

  • Observational, multicentre study including non-valvular AF patients aged 90+ on DOACs or VKAs.
  • Primary outcome: composite of ischemic stroke/transient ischemic attack (TIA) and systemic embolism (SE).
  • Secondary outcomes: major bleeding (MB), anticoagulant discontinuation, all-cause death; analyzed with competing risks.

Main Results:

  • 546 patients included (301 VKA, 245 DOAC).
  • Rates: Ischemic stroke/TIA/SE 2.4%/patient-year; MB 5.5%/patient-year.
  • No significant difference in stroke/SE or MB risk between DOACs and VKAs (SHR 0.78 and 1.43, respectively).
  • Predictors of stroke/SE: prior ischemic stroke/TIA, vascular disease. Predictor of MB: prior bleeding.

Conclusions:

  • Anticoagulant therapy in nonagenarian AF patients has a low rate of thromboembolism but a significant risk of major bleeding.
  • DOACs represent a viable option for preventing stroke/TIA/SE in this elderly group.
  • Further research is warranted to optimize anticoagulation strategies for nonagenarians.
Abstract

Keywords:
Aged, 80 and overAnticoagulantsAtrial FibrillationNonagenariansOldest old

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