197: Oral anticoagulation therapy in older patients with atrial fibrillation: an evaluation of daily practice with regard to guidelines and scores in a cohort of 142 patients

Abstract

Age is a major thrombo-embolic risk factor in atrial fibrillation (AF), but also a risk factor for bleeding under oral anticoagulation therapy (OAC). However, it appears that older patients are inadequately treated with OAC. The objective of our study was to evaluate the use of OAC in elderly patients hospitalised in a cardiology department according to current guidelines. Over a 4-month period, 142 patients over 75 years old with history of AF were included. Clinical and biological data were recorded, and risk scores for bleeding (HASBLED) and thrombo-embolic events (CHADS 2 and CHA 2 DS 2 VASc) were independently assessed after discharge. The differences between bleeding and thrombo-embolic risk were calculated for each patient. Patients with OAC at discharge and patients without OAC were compared. Mean age was 83±13 years (75 men). Mean CHADS, CHADSVASc and HASBLED scores were respectively 2,6±0,1, 4,6±0,1 and 2,3±0,1. According to CHADSVASc score and guidelines all of the patients were eligible for OAC. However 47.8% of patients were not under OAC. Those patients were older (84.6±0.6 vs. 81.8±0.5; p=0.001), predominantly female (66 vs. 35%; p=0.001) with a higher serum creatinine (127.3±7.3 vs. 106±6.3; p=0.03) and HASBLED score (2.7 vs. 2.16; p=0.001). OAC use was not associated with CHADS and CHADSVASc scores values. OAC No OAC T (CHADS) >B 49.2% 39% * T (CHADS) < B 2.3% μ 9.2% T (CHADSVASC) >B 47% 40% * T (CHADSVASC) < B 3.8% μ 8.4% T Thrombo-embolic risk; B: bleeding risk (HASBLED) according to scores * undertreated patients according to scores μ over-treated patients according to scores Our study in daily pratice confirms that OAC in older patients with AF are underused and that the bleeding risk may be over-rated and/or thrombo-embolic risk under-estimated. However, specific risk factors in older patients may not be included in currently used scores.