Abstract
BackgroundThere is controversy as to whether patients with atrial fibrillation (AF) and perceived low risk of cerebral infarction should be treated with anticoagulants, especially at what age a cut-off treatment might be indicated. MethodWe performed a retrospective, nationwide cohort study based on the Swedish National Patient Register and the Prescribed Drugs Register. Patients with a diagnosis of AF between July 1, 2005, and December 31, 2014, were included and divided into age categories (<55, 55–59, 60–64 and 65–74 years) and CHA2DS2-VA score of 0 and 1. Incidence rates (IR) of cerebral infarction and cerebral bleeding were calculated. Associations between outcomes from anticoagulant therapy and no therapy were calculated with Cox regression and given as hazard ratios (HR) with 95% confidence intervals (CI). ResultsThe analyzed cohort consisted of 294,470 patients. All age categories older than 55 years on anticoagulants had lower IR and HR for cerebral infarction compared to patients off anticoagulants, from HR 0.72, 95% CI (0.54–0.96) for patients 55–59 years with 0 points according to the CHA2DS2-VA score, to HR 0.37, 95% CI (0.33–0.42) for patients 65–74 years with 1 point. Anticoagulant therapy was associated to an increased risk of cerebral bleeding in three of seven categories, <55 years with 0 point, 55–59 years with 1 point, and 65–74 years with 1 point. ConclusionAnticoagulant therapy in patients with AF and age 55 years and older may be considered even if the patient has no other known risk factors for cerebral infarction.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia
In patients 55–59, 60–64 and 65–74 years of age, all analyzed categories indicated a benefit for anticoagulant therapy, including age category 55–59 with 0 points from the CHA2DS2-VA score, p = 0.016, hazard ratios (HR) 0.72, 95% confidence intervals (CI) (0.54–0.96) (Table 2)
In patient aged
Summary
Atrial fibrillation (AF) is the most common arrhythmia. The prevalence is difficult to calculate due to the fact that many patients are asymptomatic and may remain undiagnosed; it is estimated to be approximately 3% in the Swedish population [1]. There is controversy as to whether patients with atrial fibrillation (AF) and perceived low risk of cerebral infarction should be treated with anticoagulants, especially at what age a cut-off treatment might be indicated. All age categories older than 55 years on anticoagulants had lower IR and HR for cerebral infarction compared to patients off anticoagulants, from HR 0.72, 95% CI (0.54–0.96) for patients 55–59 years with 0 points according to the CHA2DS2-VA score, to HR 0.37, 95% CI (0.33–0.42) for patients 65–74 years with 1 point. Anticoagulant therapy was associated to an increased risk of cerebral bleeding in three of seven categories,
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
