Efficacy and safety of oral anticoagulants in elderly patients with stable coronary artery disease and atrial fibrillation

Abstract

Background This study aimed to evaluate the efficacy and safety of oral anticoagulants (OACs) in real-world elderly patients with comorbidities of stable coronary artery disease (SCAD) and atrial fibrillation (AF). Methods Elderly patients (aged ≥ 65 years old) diagnosed with SCAD and AF were consecutively recruited and grouped into patients with or without oral anticoagulant (OAC) treatment. Follow-up was performed for 5 years. Major adverse cardiac events (MACEs) were defined as a composite of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and systemic embolism. Major bleeding outcomes were defined as events that were type ≥ 3 based on the Bleeding Academic Research Consortium (BARC) criteria. The net clinical outcomes were defined as the combination of MACEs and bleeding of BARC type ≥ 3. Results A cohort of 832 eligible patients (78 ± 6.70 years) was included. Compared to the patients without OAC treatment (n = 531, 63.82%), the patients treated with OAC (n = 301, 36.18%) were much younger, had higher body mass index (BMI), and had lower prevalence of heart failure, chronic obstructive pulmonary disease (COPD), renal insufficiency, and previous myocardial infarction. During the follow-up of 5 years, compared to the patients without OAC treatment, patients with OAC had a significantly lower risk of MACEs (20.60% vs. 58.95%, adjusted HR: 0.21, 95% CI: 0.15–0.30, p < 0.001) but a higher risk of BARC ≥ 3 bleeding events (4.65% vs. 1.32%, adjusted HR: 4.71, 95% CI: 1.75–12.64, p = 0.002). In combination, a lower risk of net clinical outcomes could be observed in the patients with OACs (23.26% vs. 58.96%, adjusted HR: 0.27, 95% CI: 0.19–0.38, p < 0.001). Among the patients with OAC treatment, no significant difference was found for MACEs or BARC ≥ 3 bleeding events between the patients with or without comedications of oral antiplatelet agents. Conclusions A net clinical benefit of efficacy and safety could be observed in OAC-treated elderly patients with SCAD and AF. This benefit is independent of the comedications of oral antiplatelet treatment.

Atrial fibrillation episode status and incidence of coronary slow flow: A propensity score-matched analysis

“…AF causes various disabling symptoms, including blood pressure drops, palpitations, poor exercise tolerance, and lung congestion ( 4 ). Furthermore, even in the absence of severe coronary artery disease, patients with AF may experience symptoms caused by changes in myocardial perfusion and brief myocardial ischemia such as angina-like chest pain ( 5 , 6 ).…”

Survival benefits of oral anticoagulation therapy in acute kidney injury patients with atrial fibrillation: a retrospective study from the MIMIC-IV database

“…Consistent with the result, our study showed the benefits of OAC outweighed an increased risk of fatal side effects in dialysis patients. It is possible that, OAC might have a survival benefit not only through a reduction of thromboembolic risk, but also protecting against myocardial infarction in a considerable number of patients with AF complicated with CAD 22 23. However, OAC treatment did not significantly reduce the risk of 30-day mortality among AKI patients complicated by haemorrhage.…”

Oral anticoagulation challenges and therapeutic dilemmas in the very elderly: to treat and how to treat octogenarians and nonagenarians?

“…93 The independent net clinical benefit of OACs (and especially of DOACs) has been demonstrated in the elderly patients with stable CAD and AF. 94 However, the need for antiplatelet comedication is being extensively studied so that a particular approach can be reliably established for the elderly AF patients suffering from acute coronary syndrome or undergoing percutaneous coronary intervention (PCI). 95 All the existing trials 96-99 demonstrated that dual therapy (ie, OAC + single antiplatelet treatment, mostly clopidogrel) more significantly reduced the risk of bleeding events than triple therapy (ie, OAC + dual antiplatelet treatment [DAPT]).…”