Stroke and Major Bleeding Risk in Elderly Patients Aged ≥75 Years With Atrial Fibrillation

Abstract

The limitations of the VKAs have also been partly overcome by the availability of the non-VKA oral anticoagulants (OACs), which offer relative efficacy, safety, and convenience compared with the VKAs. 6 Ancillary analyses reporting the elderly subgroup from the large randomized trials have been reported, showing consistency in the effect size for benefits/ harms for the elderly compared with younger patients with Background and Purpose-Atrial fibrillation (AF) is increasingly prevalent in the elderly, but such patients tend to be under-represented in clinical trials. Increasing age confers a higher risk of stroke and bleeding when antithrombotic therapy is used. We examined risk factors for stroke and bleeding among elderly (age, >75 years) patients within a real world hospitalized cohort from the Loire Valley AF project. Methods-We identified elderly (age, >75 years) patients with AF, assessed their risk factors, and followed up for stroke, thromboembolism, death, or major bleeding. The effect of vitamin K antagonist (VKA) use on these end points was assessed. Results-We studied 8962 patients with AF, and we identified 4130 elderly (age, ≥75 years) patients. Using Kaplan-Meier analyses, event rates of death, stroke/thromboembolism, the composite of stroke/thromboembolism/death, and major bleeding increased with increasing age. For mortality, VKA-treated patients did better than non-VKA-treated patients. The risk of death and stroke/thromboembolism/death increased with increasing age. The risk of major bleeding did not increase with increasing age strata. VKA treatment was associated with lower mortality in those aged <75 years (adjusted hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.45-0.72), and the effect size was maintained with increasing age strata (P int =0.67). For stroke/thromboembolism/death, VKA also has a significant benefit in those aged <75 years (adjusted HR, 0.69;, and the effect size was maintained with increasing age strata (P int =0.58). For major bleeding, there was no statistically significant difference between age strata (P int =0.67). In elderly patients, age and previous stroke emerged as the main predictors of stroke and thromboembolism. Renal impairment and VKA use were predictors of major bleeding. Conclusions-Elderly patients with AF have a higher risk of stroke and bleeding, but the benefits of VKA therapy for stroke/thromboembolism or mortality were present regardless of increasing age.

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

“…Ageing is associated with an increased bleeding risk in patients on OAT: the annual risk of major bleedings in VKAs-treated patients is estimated at 2-3%, while the rate of minor bleedings is reported to be around 10-15% [1,4,[15][16][17]. A threefold increase in major bleeding risk has been reported in patients on OAT aged ≥ 85 years as compared with subjects b 60 years [18,19].…”

Efficacy and Safety of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients With Impaired Liver Function: A Retrospective Cohort Study

“…ILF is associated with increased bleeding risk and has been included in a bleeding risk scoring system for assessing the 1‐year risk of major bleeding associated with warfarin therapy in patients with AF 2, 3, 4. In addition, hepatitis‐related chronic liver disease and cirrhosis are prevalent in Asia and are associated with higher risks of ischemic stroke, portal vein thrombosis, intracranial hemorrhage, and variceal bleeding 5, 6, 7, 8.…”

Cardioembolic Stroke in Latvia: Prevention and Long-Term Outcome

“…Conclusion was that elderly patients with AF have a higher risk of stroke and bleeding, but the benefits of VKA therapy for stroke/thromboembolism or mortality were present regardless of increasing age (Lip et al, , 2014). …”