Oral anticoagulation reduced all-cause mortality (OR 0.59; 95% CI 0.36-0.99), while antiplatelet monotherapy increased stroke risk (OR 2.45; 95% CI 1.05-5.70) in very elderly AF patients.
Cohort (n=2,259)
Yes
Does oral anticoagulation compared to antiplatelet monotherapy reduce stroke and death in very elderly (≥85 years) patients with atrial fibrillation?
In very elderly patients (≥85 years) with atrial fibrillation, oral anticoagulation reduces mortality, whereas antiplatelet monotherapy increases stroke risk, highlighting the underuse of OAC in this high-risk population.
Effect estimate: OR 0.59 (95% CI 0.36-0.99)
Objectives: to examine the use of antithrombotic therapy and predictors of stroke and death in very elderly (≥85 years) atrial fibrillation (AF) patients in a general practice cohort from the UK. Design: retrospective, observational cohort study; 12-month follow-up period. Setting: eleven general practices serving the town of Darlington, England representing a population of 105,000 patients. Patients: two thousand two hundred and fifty-nine patients with a history of AF, 561 (24.8%) aged ≥85 years. Main outcome measures: use of antithrombotic therapy by age group and predictors of stroke and death. Results: five hundred and sixty-one (24.8%) AF patients aged ≥85 years (mean (SD) age 89 (4) years; 66% female) identified with a mean CHA2DS2-VASc score of 4.6 (SD 1.4). Thirty-six per cent received oral anticoagulation (OAC) compared with 57% in the 75–84 years age group. Forty-nine per cent of the very elderly received antiplatelet (AP) monotherapy; recorded OAC contraindications and declines were greatest among those aged ≥85 years. Stroke risk was highest among the very elderly (5.2% per annum), despite anticoagulation (3.9%). Multivariate analyses demonstrated an increased risk of stroke with AP monotherapy (odds ratio (OR) 2.45, 95% confidence intervals (CIs) 1.05–5.70) and a significant reduction in all-cause mortality with OAC therapy (OR 0.59, 95% CI 0.36–0.99). Conclusion: the majority of very elderly AF patients in general practice do not receive OAC despite their higher stroke risk; almost half received AP monotherapy. AP use independently increased the risk of stroke, signifying that effective stroke prevention requires OAC regardless of age, except where true contraindications exist.
Wolff et al. (Tue,) conducted a cohort in Atrial fibrillation (n=2,259). Oral anticoagulation (OAC) vs. Antiplatelet (AP) monotherapy was evaluated on all-cause mortality (OR 0.59, 95% CI 0.36-0.99). Oral anticoagulation reduced all-cause mortality (OR 0.59; 95% CI 0.36-0.99), while antiplatelet monotherapy increased stroke risk (OR 2.45; 95% CI 1.05-5.70) in very elderly AF patients.