Key result
Patients >80 years with atrial fibrillation were significantly less likely to receive warfarin than those <80 years (25.5% vs 61.5%, P<0.0001) and 5.46 times more likely to receive aspirin.
Why the study?
Does advanced age (>80 years) influence the selection of antithrombotic therapy in elderly patients with non-valvular atrial fibrillation?
Observational (n=262)
No
Does advanced age (>80 years) influence the selection of antithrombotic therapy in elderly patients with non-valvular atrial fibrillation?
Odds Ratio: 5.46
Absolute Event Rate: 25.5% vs 61.5%
p-value: p=<0.0001
Advanced age (>80 years) is the largest contributing factor for withholding warfarin in preference to aspirin in elderly patients with atrial fibrillation, independent of recognized contraindications.
May influence anticoagulation decisions in octogenarians with AF; leaves open whether age bias or appropriate caution drives observed patterns.
Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients >65 years, who were admitted to a Sydney teaching hospital over a 12‐month period. Results: Overall, 202 (79%) patients were discharged on some antithrombotic therapy. Patients <80 years were as likely to receive antithrombotic therapy as those <80 years (75.8% versus 81.9%, P=0.23), but a significantly lower proportion received warfarin than did those <80 years (25.5% versus 61.5%, P < 0.0001). Definite contraindications to anticoagulation were a significant influence on antithrombotic agent selection (P=0.04), but multivariate analysis indicated that ‘old age’ was the largest contributing factor: patients >80 years were 5.46 times more likely to receive aspirin in preference to warfarin than their younger counterparts (P<0.0001). Conclusion: Warfarin is being withheld in AF patients ≥80 years for reasons other than recognised contraindications and is, therefore, potentially underutilised in the target elderly population. Further studies are necessary to determine whether this is appropriate.
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Bajorek et al. (2002) conducted an observational in Atrial fibrillation (n=262). Age >80 years vs. Age <80 years was evaluated on Receipt of warfarin (OR 5.46, p=<0.0001). Patients >80 years with atrial fibrillation were significantly less likely to receive warfarin than those <80 years (25.5% vs 61.5%, P<0.0001) and 5.46 times more likely to receive aspirin.
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