Benefit of Anticoagulation in the Elderly with Atrial Fibrillation

Guidelines recommend oral anticoagulation for all ≥ 75-year-old patients with atrial fibrillation. However, there is little evidence as to its net clinical benefit in the elderly population.

anticoagulated patients that receive angioplasty

This study looked at the life net clinical benefit in atrial fibrillation patients over 75 years of age treated with warfarin or apixaban vs. no treatment.

Researchers observed stroke, bleeding and death rates, and the odds of this happening according to stroke and bleeding risk, and life expectancy of each particular patient. 

The study included 14946 patients of mean 81 years and CHA₂DS₂-VASc score of 4.


Read also: Percutaneous Annuloplasty in Functional Mitral Regurgitation vs. Sham Procedure.


In the main analysis, being over 87 cancelled the clinical benefit of warfarin while apixaban this happened as of 92 years of age. 

A life expectancy over 3 years resulted in higher net clinical benefit too. 

Conclusion

The net clinical benefit of anticoagulation in patients with atrial fibrillation reduces over time. Physicians should consider age and life expectancy when indicating anticoagulation to the elderly. 

2019-12-06-10-1161-CIRCOUTCOMES-119.006212

Original Title: Net Clinical Benefit of Oral Anticoagulation Among Older Adults With Atrial Fibrillation.

Reference: Sachin J. Shah et al. Circ Cardiovasc Qual Outcomes. 2019 Nov;12(11):e006212.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

Ultrathin vs Thin-Strut Stents in PCI Patients at High Bleeding Risk

Several in vivo studies have shown that ultrathin stents present lower thrombogenic risk vs. thin-strut stents, which reflects in lower rates of target lesion...

Should We Withdraw Anticoagulation Before TAVR?

Approximately one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have atrial fibrillation and are on oral anticoagulant (OAC) therapy. This creates a complex...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....