Abstract
BackgroundAnnually > 10% of patients with atrial fibrillation on oral anticoagulation undergo invasive procedures. Optimal peri-procedural management of anticoagulation, as judged by major bleeding and thromboembolic events, especially in the elderly, is still debated.MethodsProcedures from 1442 patients were evaluated. Peri-procedural edoxaban management was guided only by the experience of the attending physician. The primary safety outcome was the rate of major bleeding. Secondary outcomes included the peri-procedural administration of edoxaban, other bleeding events, and the main efficacy outcome, a composite of acute coronary syndrome, non-hemorrhagic stroke, transient ischemic attack, systemic embolic events, deep vein thrombosis, pulmonary embolism, and mortality.ResultsOf the 1442 patients, 280 (19%) were < 65, 550 (38%) were 65–74, 514 (36%) 75–84, and 98 (7%) were 85 years old or older. With increasing age, comorbidities and risk scores were higher. Any bleeding complications were uncommon across all ages, ranging from 3.9% in patients < 65 to 4.1% in those 85 years or older; major bleeding rates in any age group were ≤ 0.6%. Interruption rates and duration increased with advancing age. Thromboembolic events were more common in the elderly, with all nine events occurring in those > 65, and seven in patients aged > 75 years.ConclusionDespite increased bleeding risk factors in the elderly, bleeding rates were small and similar across all age groups. However, there was a trend toward more thromboembolic complications with advancing age. Further efforts to identify the optimal management to reduce ischemic complications are needed.Trial registration: NCT# 02950168, October 31, 2016
Highlights
> 10% of patients with atrial fibrillation on oral anticoagulation undergo invasive procedures
With over 33 million patients with AF (2010 data) globally [6], there is a large population at need of oral anticoagulation in atrial fibrillation to reduce the risk of thromboembolic events
HAS-BLED and C HA2DS2-VASc scores increased with age, in the over 75 age groups
Summary
> 10% of patients with atrial fibrillation on oral anticoagulation undergo invasive procedures. Optimal peri-procedural management of anticoagulation, as judged by major bleeding and thromboembolic events, especially in the elderly, is still debated. Aging is associated with a decline of many physiologic functions, determined by factors that include genetic predisposition, environmental influences, and lifestyle choices. The number and severity of risk factors increases in the elderly, leading to a higher incidence of diseases such as atrial fibrillation (AF), along with sequelae such as systemic thromboembolism and stroke [2]. With over 33 million patients with AF (2010 data) globally [6], there is a large population at need of oral anticoagulation in atrial fibrillation to reduce the risk of thromboembolic events
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