Abstract
BackgroundThe safety and efficacy of an oral anticoagulant (OAC) treatment and the difference between direct OACs (DOACs) and warfarin in nonsevere frail elderly patients with AF are unclear.MethodsThis was a retrospective and observational study of 354 patients over 80 years of age with nonsevere frailty who were diagnosed with AF and treated with OACs. Nonsevere frailty was defined as a clinical frailty scale score of <7. Bleeding and thromboembolic events during the OAC treatment were followed up.ResultsOf 354 patients enrolled, 273 (77.1%) received DOACs and 81 (22.9%) received warfarin. Of 273 patients receiving DOACs, there were 210 (76.9%) prescribed with appropriate doses of DOACs. Of 81 warfarin‐treated patients, 53 (65.4%) were prescribed an appropriate dose of warfarin. During a follow‐up of 33.1 (14.0‐51.0) months, 15 patients (1.5/100 person‐years) had bleeding events and 10 (1.0/100 person‐years) had thromboembolic events while on an OAC treatment. The incidence ratio of bleeding events in patients receiving DOACs was lower than that in those receiving warfarin (1.0/100 person‐years vs 2.9/100 person‐years, hazard ratio [HR]: 0.26, 95% confidence interval [CI]: 0.07‐0.91, P = .036). There was no significant difference in the incidence of thromboembolic events between the DOAC and warfarin treatment groups (0.88/100 person‐years vs 1.4/100 person‐years, HR: 0.63, 95% CI: 0.16‐2.57, P = .52).ConclusionsOACs are substantially safe and effective for preventing thromboembolic events in nonsevere frail patients over 80 years of age. Particularly, DOACs can be used more safely than warfarin.
Highlights
Atrial fibrillation (AF) is the most common type of arrhythmia in clin‐ ical practice
Frailty was assessed with the Clinical Frailty Scale (CFS) of the Canadian Study on Health & Aging, which has been verified as a useful rapid assessment tool of frailty.[6,7]
The occurrence ratio of bleeding events in patients receiving direct OACs (DOACs) was lower than that in those receiv‐ ing warfarin (1.0/100 person‐years person‐year vs 2.9/100 person‐ years, hazard ratio [HR]: 0.26, 95% CI: 0.07‐0.91, P = .036)
Summary
Atrial fibrillation (AF) is the most common type of arrhythmia in clin‐ ical practice. It is estimated that AF is associated with approximately 30% of ischemic strokes in patients over 80 years of age.[1]. The evaluation of frailty is important to help assess the suitability of an oral anticoagulant (OAC) treatment for preventing thrombo‐ embolic events in AF patients. In severe frail elderly patients with AF, it may be ap‐ propriate to use no anticoagulation to avoid bleeding events.[4]. There are limited data about the safety and efficacy of an OAC treatment in octogenarians whose frailty is not so severe. The objective of this study was to evaluate the safety and effi‐ cacy of an OAC treatment and the difference between direct OACs (DOACs) and warfarin for the management of AF among nonsevere frail patients over 80 years of age
Sign-in/Register to view highlights & summary 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.
