Direct oral anticoagulants provide benefits compared with warfarin for stroke prophylaxis in older adults with atrial fibrillation, despite their general under-representation in clinical trials.
Direct OACs and appropriately selected invasive procedures are beneficial for managing AF in adults ≥75 years, despite higher complication risks and under-representation in clinical trials.
The prevalence of atrial fibrillation (AF) is increasing as the population ages. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Syncope and fall-related injuries are the most common reasons for nonprescription of oral anticoagulation (OAC), and are more common in older adults when OACs are used with antiarrhythmic drugs. Digoxin may be useful for rate control, but associations with increased mortality limit its use. Beyond rate and rhythm control considerations, stroke prophylaxis is critical to AF management, and the benefits of direct OACs, compared with warfarin, extend to older adults. Invasive procedures such as AF catheter ablation, pacemaker implantation/atrioventricular junction ablation, and left atrial appendage occlusion may be useful in appropriately selected cases. However, older adults have generally been under-represented in clinical trials.
Volgman et al. (Sat,) conducted a review in Atrial fibrillation. Management of Atrial Fibrillation was evaluated. Direct oral anticoagulants provide benefits compared with warfarin for stroke prophylaxis in older adults with atrial fibrillation, despite their general under-representation in clinical trials.
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