Oral Anticoagulants in Very Elderly Nonvalvular Atrial Fibrillation Patients With High Bleeding Risks

Figures

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  Figure 1. Patient Disposition A total of 32,275 patients were enrolled in the ANAFIE registry, of whom 7,104 (22.0%) met the eligibility criteria for the ELDERCARE-AF trial (high-risk group). These criteria were age of ≥80 years; a CHADS2 score of ≥2; and the presence of ≥1 bleeding risk factor: creatinine clearance of 15-30 mL/min; patients with CrCl of <15 mL/minute or undergoing dialysis; prior bleeding history at critical sites (ie, major upper or lower gastrointestinal bleeding or intracranial hemorrhage); body weight of ≤45 kg; and continuous single antiplatelet use (eg, aspirin, P2Y12 inhibitor, or other) did not meet the ELDERCARE-AF trial inclusion criteria. The reference group was composed of the 25,171 patients (78.0%) who did not meet the ELDERCARE-AF criteria. ANAFIE = All Nippon Atrial Fibrillation in the Elderly; ELDERCARE-AF = Edoxaban Low-Dose for Elder Care Atrial Fibrillation Patients.

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  Central Illustration. Kaplan–Meier Curves for the Main Outcomes The criteria for inclusion in the ELDERCARE-AF–like high-risk group were age of ≥80 years, a CHADS2 score of ≥2, and the presence of ≥1 bleeding risk factor: creatinine clearance of 15-30 mL/min; prior bleeding history at critical sites; body weight of ≤45 kg; and continuous single antiplatelet use. The reference group included all other patients. Cumulative incidence rates are shown for the main outcomes of stroke/systemic embolism, major bleeding, cardiovascular events, and all-cause death. The high-risk group had higher cumulative incidences of all these events compared with the reference group (P < 0.001). ELDERCARE-AF = Edoxaban Low-Dose for Elder Care Atrial Fibrillation Patients.

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  Figure 2. Kaplan-Meier Curves for Intracranial Hemorrhage and Gastrointestinal Bleeding Cumulative incidence rates are shown for intracranial hemorrhage and gastrointestinal bleeding. The high-risk group had higher cumulative incidences of gastrointestinal bleeding (P < 0.001) and intracranial hemorrhage (P = 0.003) compared with the reference group.