Key result
Frailty in elderly NVAF is linked to ~2.3-fold higher 12-month bleeding risk.
Why the study?
It was uncertain whether anticoagulation is safe for frail and non-frail elderly patients with nonvalvular atrial fibrillation.
Does anticoagulation therapy and frailty status affect the risk of thromboembolism, bleeding, all-cause death, and cardiovascular events in elderly patients (aged ≥75 years) with nonvalvular atrial fibrillation?
Cohort (n=361)
No
Does anticoagulation therapy and frailty status affect the risk of thromboembolism, bleeding, all-cause death, and cardiovascular events in elderly patients (aged ≥75 years) with nonvalvular atrial fibrillation?
In patients aged ≥75 years with nonvalvular atrial fibrillation, frailty independently predicts higher bleeding and all-cause mortality over 12 months, whereas anticoagulation therapy is associated with numerically lower thrombotic events and higher overall bleeding without increasing major or fatal bleeding.
Answers are grounded in this paper and cite their sources.
Frailty signals elevated bleeding and mortality risk in elderly NVAF; leaves open anticoagulation's net benefit pending randomized data.
Objective: This study explored whether anticoagulation is safe for frail and non-frail elderly patients who have nonvalvular atrial fibrillation (NVAF). Methods: At hospital discharge, the anticoagulant regimen and frailty status were recorded for 361 elderly patients (aged ≥ 75 y) with NVAF. The patients were followed for 12 months. The endpoints included occurrence of thrombosis; bleeding; all-cause death; and cardiovascular events. Results: At hospital discharge, frailty affected 50.42% of the population and the anticoagulation rate was 44.04%. At discharge, age (OR 0.948, P = 0.006), paroxysmal NVAF (OR 0.384, P < 0.001), and bleeding history (OR 0.396, P = 0.001) were associated with a decrease in rate of receiving anticoagulation, while thrombotic events during hospitalization (OR 2.281, P = 0.021) were associated with an increase. Relative to non-frail patients, those with frailty showed a higher rate of ischemic stroke (5.33% cf. 3.01%), bleeding ( P = 0.006) events, and all-cause mortality ( P = 0.001). Relative to the group without anticoagulation, in those with anticoagulation the rate of thrombotic events was lower (6.99 cf. 10.98%) and bleeding events were higher (20.98 cf. 12.72%), but the risk of major bleeding was comparable. Conclusion: In the elderly patients with NVAF, the decision toward anticoagulation therapy at hospital discharge was influenced by age, bleeding history, paroxysmal atrial fibrillation diagnosis, and absence of thrombosis. Frail patients were at greater risk of bleeding and all-cause mortality. Anticoagulation tended to reduce the risk of thrombotic events.
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Ding et al. (2024) conducted a cohort in Nonvalvular atrial fibrillation (NVAF) (n=361). Anticoagulation therapy and frailty status vs. No anticoagulation therapy / non-frail status was evaluated on Bleeding events (associated with frailty at 12 months) (HR 2.294, 95% CI 1.264-4.160, p=0.006). Frailty in elderly NVAF patients increased 12-month risks of bleeding and all-cause death, while anticoagulation did not increase major bleeding.
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