Impact of age on thromboembolic events in patients with non‐valvular atrial fibrillation

Abstract

BackgroundAge is a well‐established risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the mechanism underlying the association between age and thromboembolic events in AF remains unknown.MethodsThe prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large‐scale single‐center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients.ResultsNHIS sample cohort data including 5896 patients with AF revealed that the risk of thromboembolic complication differed significantly according to age despite equal CHA2DS2‐VASc score. In the registry of 2801 patients, age showed significant correlations with left atrium (LA) diameter, LA volume, E/e′, pulmonary artery pressure, and LA appendage flow velocity. Older patients had a significantly higher prevalence of spontaneous echocontrast (odds ratio [OR] = 1.030; P < .001). Age (OR = 1.031; P < .001), E/e′ (OR = 1.065; P = .004), and LA appendage flow velocity (OR = .988; P = .009) were significant predictors for thromboembolic events in multivariate analyses. In data from the NHIS, CHA2DS2‐VASc score did not outperform age to predict thromboembolic events.ConclusionsAge is a significant risk factor for thromboembolic events in patients with AF, and old age is associated with adverse cardiac hemodynamics. This study suggests that older patients with AF are at high risk of thromboembolic events regardless of CHA2DS2‐VASc score.

Clinical factors associated with safety and efficacy in patients receiving direct oral anticoagulants for non-valvular atrial fibrillation

“…Conversely, occurrence of MACCE showed little difference between patient groups. In comparison with previous data that showed an age-related increase in cerebral thrombosis in patients with AF when anticoagulants were not administered, the present results imply that DOACs successfully suppressed the development of thrombosis among the very elderly [16][17][18][19][21][22][23] . According to a prospective cohort study that 24 .…”

“…However, clinicians might want to know which type of bleeding would increase, the severity and frequency, and related background factors. Unfortunately, we do not yet have answers to these questions, and information about the safety of DOACs for very elderly AF patients remains limited [16][17][18][19] . Observation of clinical event.…”

Blood flow volume of left atrial appendage measured by magnetic resonance imaging is improved after radiofrequency catheter ablation of atrial fibrillation

“…Function of LAA is difficult to measure and TEE is virtually the only available option. Although abnormal LAA function is a known risk factor for ischemic stroke in AF patients, it is not incorporated into CHA 2 DS 2 ‐VASc scoring system 4–8,22 . Main reason is that TEE (i) is an invasive imaging test; (ii) has rare but serious complications, such as esophageal injury; (iii) is associated with patient discomfort related with the insertion of the probe usually requiring sedatives; and (iv) requires well trained cardiologist to perform and therefore is not an anytime available test.…”

Current status of proton pump inhibitor use in Japanese elderly patients with non-valvular atrial fibrillation: A subanalysis of the ANAFIE Registry

“…Elderly NVAF patients are not only at an increased risk of stroke but also at an increased risk of bleeding [ 3 , 10 , 11 ]; thus, the benefits of anticoagulation must be weighed against the potential for bleeding events, including GI bleeding [ 15 , 16 ]. PPIs have been shown to reduce GI bleeding in patients receiving antiplatelet therapy [ 26 ], and a recent study suggested that PPIs may also reduce the GI bleeding risk in patients receiving anticoagulants [ 19 ].…”

“…As the prevalence of non-valvular AF (NVAF) increases with age [ 9 ], appropriate anticoagulation is particularly important among the elderly, as this group is not only at the greatest risk of stroke attributable to AF [ 3 , 10 ] but also of bleeding [ 11 , 12 ]. Clinicians must consider both the benefits and risks before prescribing an anticoagulant, as such therapy may increase the risk of bleeding [ 13 , 14 ].…”