What question did this study set out to answer?

To assess the effectiveness and clinical safety of oral anticoagulants, including direct oral anticoagulants compared with warfarin, in frail older patients with atrial fibrillation.

February 3, 2022StrokeOpen Access

OAC use was associated with a lower risk of net adverse clinical events compared to no OAC use (HR 0.78, 95% CI 0.75–0.82).

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Why the study?

Frail patients with AF are less likely to receive anticoagulation despite frailty being associated with poorer outcomes including stroke, leaving the effectiveness and safety of OACs in this population unclear.

Does oral anticoagulation improve net adverse clinical events in frail older patients with atrial fibrillation?

Population

83 635 patients aged at least 65 years with AF and frailty from Korea

Comparison

OAC use vs no OAC use, and direct OACs vs warfarin

Design

Retrospective propensity score-weighted cohort study

Discussion

Member takes

Overview

OAC use may warrant consideration in frail AF despite underuse; leaves open confirmation of net benefit in randomized trials.

Key Points

To assess the effectiveness and clinical safety of oral anticoagulants, including direct oral anticoagulants compared with warfarin, in frail older patients with atrial fibrillation.
Retrospective cohort study of 83,635 frail patients aged ≥65 years with atrial fibrillation (Hospital Frailty Risk Score ≥5) identified from the Korean National Health Insurance Service database (2013–2016).
Propensity score–weighting was implemented to balance baseline covariates between oral anticoagulant users versus non-users and among specific anticoagulant classes.
Compared with non-use, oral anticoagulant use reduced net adverse clinical events (HR, 0.78 [95% CI, 0.75–0.82]), ischemic stroke (HR, 0.91 [95% CI, 0.86–0.97]), and cardiovascular death (HR, 0.52 [95% CI, 0.49–0.55]), without increasing major bleeding (HR, 1.02 [95% CI, 0.95–1.10]).
Direct oral anticoagulants significantly decreased risks of net adverse clinical events, ischemic stroke, major bleeding, and cardiovascular death compared with warfarin, with pronounced benefits in patients with a CHA2DS2-VASc score ≥3.

Structured PICO

Does oral anticoagulation improve net adverse clinical events in frail older patients with atrial fibrillation?

Population

83,635 patients aged ≥65 years with atrial fibrillation and frailty (≥5 Hospital Frailty Risk Score), mean age 78.5, 57.1% women, from the Korean National Health Insurance Service database.

Intervention

Oral anticoagulants (OACs), including direct oral anticoagulants (DOACs)

Comparator

No OAC use (and warfarin as an active comparator for DOACs)

Outcome

Net adverse clinical event (first event of ischemic stroke, major bleeding, or cardiovascular death)composite

In frail older patients with atrial fibrillation, oral anticoagulation (particularly DOACs) is associated with improved net clinical outcomes without significantly increasing major bleeding compared to no treatment.

Cite This Study

A 2022 study studied this question.

synapsesocial.com/papers/6a867efd6c87af29fecc6ed0 https://doi.org/10.1161/strokeaha.121.036757

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February 3, 2022StrokeOpen Access

OAC use was associated with a lower risk of net adverse clinical events compared to no OAC use (HR 0.78, 95% CI 0.75–0.82).

View Full Paper

Ask AI

Bookmark

Why the study?

Does oral anticoagulation improve net adverse clinical events in frail older patients with atrial fibrillation?

Population

83 635 patients aged at least 65 years with AF and frailty from Korea

Comparison

OAC use vs no OAC use, and direct OACs vs warfarin

Design

Retrospective propensity score-weighted cohort study

Discussion

Member takes

Overview

OAC use may warrant consideration in frail AF despite underuse; leaves open confirmation of net benefit in randomized trials.

Key Points

To assess the effectiveness and clinical safety of oral anticoagulants, including direct oral anticoagulants compared with warfarin, in frail older patients with atrial fibrillation.
Retrospective cohort study of 83,635 frail patients aged ≥65 years with atrial fibrillation (Hospital Frailty Risk Score ≥5) identified from the Korean National Health Insurance Service database (2013–2016).
Propensity score–weighting was implemented to balance baseline covariates between oral anticoagulant users versus non-users and among specific anticoagulant classes.
Compared with non-use, oral anticoagulant use reduced net adverse clinical events (HR, 0.78 [95% CI, 0.75–0.82]), ischemic stroke (HR, 0.91 [95% CI, 0.86–0.97]), and cardiovascular death (HR, 0.52 [95% CI, 0.49–0.55]), without increasing major bleeding (HR, 1.02 [95% CI, 0.95–1.10]).
Direct oral anticoagulants significantly decreased risks of net adverse clinical events, ischemic stroke, major bleeding, and cardiovascular death compared with warfarin, with pronounced benefits in patients with a CHA2DS2-VASc score ≥3.

Structured PICO

Does oral anticoagulation improve net adverse clinical events in frail older patients with atrial fibrillation?

Population

83,635 patients aged ≥65 years with atrial fibrillation and frailty (≥5 Hospital Frailty Risk Score), mean age 78.5, 57.1% women, from the Korean National Health Insurance Service database.

Intervention

Oral anticoagulants (OACs), including direct oral anticoagulants (DOACs)

Comparator

No OAC use (and warfarin as an active comparator for DOACs)

Outcome

Net adverse clinical event (first event of ischemic stroke, major bleeding, or cardiovascular death)composite

Cite This Study

A 2022 study studied this question.

synapsesocial.com/papers/6a867efd6c87af29fecc6ed0 https://doi.org/10.1161/strokeaha.121.036757

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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