Effects of Oral Anticoagulant Therapy in Medical Inpatients ≥65 Years With Atrial Fibrillation

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

“…Several observational studies on AF older patients recently demonstrated a clinical benefit of warfarin, mainly due to reduced mortality and ischemic stroke incidence [35,[47][48][49][50], thereby confirming the results from previous RCTs [28,29,40,[43][44][45] also in this group of complex patients. Meanwhile, in this population, DOACs have demonstrated an equal or greater efficacy than warfarin in stroke prevention and a reduced risk of intracranial hemorrhages, as confirmed by RCTs subanalyses and real-world observational studies Table 3 Efficacy and safety outcomes in patients ≥ 75 years from sub-analysis of Phase III RCTs on DOACs.…”

“…In a retrospective study including 980 hospital-discharged older AF patients (mean age 83 years), with high prevalence of functional dependence and cognitive impairment and high post-discharge mortality, we have observed that warfarin was associated with a significant reduction in overall mortality after multivariate analysis and propensity score matching [49]. In another retrospective study including 1827 community-dwelling subjects ≥ 65 years with AF, Pilotto et al have shown that warfarin was associated with significantly reduced overall mortality in all patients, including those with the highest mortality risk according to the MPI-SVaMA [35].…”

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

“…Advanced age per se, physician's perceived high risk of age-related and fall-related bleeding, and difficulties in monitoring warfarin-based anticoagulant therapy have been reported among the main factors accounting for underprescription of anticoagulant therapy in older patients with AF [41,[43][44][45]. Although several studies suggest that advanced age itself should not prevent prescription of oral anticoagulants in the elderly patients [46][47][48], under-prescription of anticoagulants among the oldest patients remains a common clinical practice in several contemporary medical settings [15,45]. Among the perceived or actual barriers to warfarin use in older subjects with AF, the predisposition to falls represents an important issue [49].…”

“…The BAFTA study demonstrates that warfarin is more effective than aspirin in preventing ischaemic stroke in older patients with AF [46]. Furthermore, compared with warfarin, antiplatelet therapy does not seem to be associated with a lower bleeding risk in the elderly [46,47]. In the ATRIA study, the net clinical benefit of warfarin, expressed as thromboembolic events prevented minus the annualized rate of ICH, was better than aspirin net clinical benefit, and the benefit was the greatest in patients aged 85 years and over and in those at high cardioembolic risk [54].…”

Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

“…In a retrospective cohort observational study on 980 patients with mean age 83 years, ischemic and hemorrhagic stroke occurred in 12.3% and 1.3% of patients, respectively, and major bleedings in 4.4% of patients: use of VKA was independently associated with reduced mortality and with a non-significant reduction in incidence of ischemic stroke, without excess in bleeding risk. 17 No clear gender related differences have been found in elderly patients with AF about risk of major adverse events: in a large, multicenter observational study including 4093 elderly patients who started VKA treatment after the age of 80 years, elderly males showed a higher rate of bleeding complications, and females showed a slightly higher rate of stroke, thus suggesting the possibility of a higher net clinical benefit of anticoagulant treatment in females. 18 Therefore, basing on literature data, it is strikingly evident that OAT is associated to a net clinical benefit, which increases with age.…”