Oral Anticoagulants in Very Elderly Atrial Fibrillation Patient

Warfarin and non-vitamin K oral anticoagulants both showed clinical benefit in very elderly atrial fibrillation (AFib) patients, according to a large new Taiwanese cohort study published in Circulation. The researchers, seeking to assess the risk of ischemic stroke and intracranial hemorrhage in very elderly (older than 90 years) patients treated with warfarin and oral anticoagulants, included 15,756 patients over 90 years of age and with AFib in the analysis.

Of those, 11,064 did not have antithrombotic therapy and 4,075 had some form of antiplatelet therapy; 617 patients were being treated with warfarin. The authors then compared 11,064 patients with AFib to 14,658 patients over 90 years of age without Atrial Fibrillation and not taking antithrombotic therapy. There were 2,141 ischemic strokes, 337 intracranial hemorrhages and 14,973 deaths (9,157 in the Atrial Fibrillation group and 5,816 in the non-AFib group).  

According to the results, elderly anticoagulated patients showed no significant difference in ischemic stroke (5.04%/year vs. 5.75%/year; adjusted HR=0.91; 95%, CI, 0.80–1.04). Those taking warfarin, however, were associated with lower ischemic stroke risk (3.83%/year vs. 5.75%/year; HR=0.65; 95% CI, 0.47–0.91). Warfarin was also associated with lower risk for ischemic stroke after adjusting for competing risk of death (HR=0.69; 95% CI, 0.49–0.96). 

They researchers also reported that anticoagulant use in this patient population was associated with a reduced risk for intracranial hemorrhage compared to a reference population treated with warfarin (0.42%/year vs. 1.63%/year; adjusted HR=0.32; 95% CI, 0.10–0.97; P=0.044) 

“Compared with warfarin, non-vitamin K oral anticoagulants were associated with a lower risk of intracranial hemorrhage,” they wrote in their conclusion. “Thus, oral anticoagulants may still be considered as thrombophrophylaxis for elderly patients, with non-vitamin K oral anticoagulants being the more favorable choice.” 

Source: Circulation