Risks Versus Benefits of Antithrombotic Therapy in Very Elderly Patients With NVAF

Researchers from the Department of Cardiology at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University in Guangzhou, Guangdong Province, China, led by primary investigator, U Fan O, theorized that the prognostic benefits of prophylactic antithrombotic therapies was more significant than the risk of bleeding in elderly patients over 85 years old. Their study, published in the International Journal of Cardiology, Heart & Vasculature, reported that vitamin K antagonists (VKA) and non-vitamin K antagonist oral anticoagulants (NOACs) appeared to reduce stroke incidence and improve prognosis in patients from different age groups with non valvular atrial fibrillation (NVAF).

This conclusion was based on an analysis of 3,524 consecutively enrolled patients with NVAF who completed the study’s follow-up period. Among the participants, 2,012 patients were not on anticoagulation therapy, 665 were on antiplatelet (AP) agents, 371 were on VKAs, and 476 were on NOACs. Additionally, 1,252 patients were considered as very elderly (>85 years of age). The primary measure of the analysis was the first occurrence of ischemic stroke, major bleeding, clinically relevant non-major gastrointestinal bleeding (CRNM-GIB), and all-cause mortality rate.

Over a median follow up time of 3.80 years (interquartile range [IQR] = 1.89–6.56), the study’s collaborators observed thromboembolic events in 610 (17.31%) patients, of which 167 were strokes and 483 were transient ischemia attacks or stroke (TIA/stroke). Additionally, bleeding events occurred in 614 patients, 131 of which were classified as major, 381 as CRNM-GIB, and 102 as minor bleeding events. The rate of all-cause mortality was 13.71% (n = 483). Notably, patients receiving NOACs (hazard ratio [HR] = 0.038; 95% confidence interval [CI], 0.004–0.401; p = 0.006) or VKAs (HR = 0.544; 95% CI, 0.307–0.965; p = 0.037) had fewer strokes. Major bleeding events also did not significantly increase in very elderly patients with NVAF receiving NOACs, despite a higher rate of CRNM-GIB events.

The authors ultimately concluded that “the prognostic benefits of NOACs outweighh their bleeding risks in very elderly patients with NVAF.”