Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation)
BackgroundIncreasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1‐year outcome with different antithrombotic approaches in very...
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| Format: | Article |
| Language: | English |
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Wiley
2017-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.005657 |
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| author | Giuseppe Patti Markus Lucerna Ladislav Pecen Jolanta M. Siller‐Matula Ilaria Cavallari Paulus Kirchhof Raffaele De Caterina |
| author_facet | Giuseppe Patti Markus Lucerna Ladislav Pecen Jolanta M. Siller‐Matula Ilaria Cavallari Paulus Kirchhof Raffaele De Caterina |
| author_sort | Giuseppe Patti |
| collection | DOAJ |
| description | BackgroundIncreasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1‐year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. Methods and ResultsWe accessed individual patients’ data from the prospective PREFER in AF (PREvention oF thromboembolic events‐European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups. A total of 6412 patients, 505 of whom were aged ≥85 years, were analyzed. In patients aged <85 years, the incidence of thromboembolic events was 2.8%/year without OAC versus 2.3%/year with OAC (0.5% absolute reduction); in patients aged ≥85 years, it was 6.3%/year versus 4.3%/year (2% absolute reduction). In very elderly patients, the risk of major bleeding was higher than in younger patients, but similar in patients on OAC and in those on antiplatelet therapy or without antithrombotic treatment (4.0%/year versus 4.2%/year; P=0.77). OAC was overall associated with weighted net clinical benefit, assigning weights to nonfatal events according to their prognostic implication for subsequent death (−2.19%; CI, −4.23%, −0.15%; P=0.036). We found a significant gradient of this benefit as a function of age, with the oldest patients deriving the highest benefit. ConclusionsBecause the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of OAC is highest in very elderly patients, where it, by far, outweighs the risk of bleeding, with the greatest net clinical benefit in such patients. |
| first_indexed | 2024-04-13T15:36:00Z |
| format | Article |
| id | doaj.art-e779d492e437438a98de4649497784bf |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T15:36:00Z |
| publishDate | 2017-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e779d492e437438a98de4649497784bf2022-12-22T02:41:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-07-016710.1161/JAHA.117.005657Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation)Giuseppe Patti0Markus Lucerna1Ladislav Pecen2Jolanta M. Siller‐Matula3Ilaria Cavallari4Paulus Kirchhof5Raffaele De Caterina6Department of Cardiovascular Sciences, Campus Bio‐Medico University of Rome, ItalyDaiichi Sankyo Europe, Munich, GermanyInstitute of Informatics, Academy of Sciences of Czech Republic, Prague, Czech RepublicDepartment of Cardiology, Medical University of Vienna, AustriaDepartment of Cardiovascular Sciences, Campus Bio‐Medico University of Rome, ItalyInstitute of Cardiovascular Sciences, University of Birmingham, United KingdomG. d'Annunzio University of Chieti and Center of Excellence on Aging CeSI‐Met, Chieti, ItalyBackgroundIncreasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1‐year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. Methods and ResultsWe accessed individual patients’ data from the prospective PREFER in AF (PREvention oF thromboembolic events‐European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups. A total of 6412 patients, 505 of whom were aged ≥85 years, were analyzed. In patients aged <85 years, the incidence of thromboembolic events was 2.8%/year without OAC versus 2.3%/year with OAC (0.5% absolute reduction); in patients aged ≥85 years, it was 6.3%/year versus 4.3%/year (2% absolute reduction). In very elderly patients, the risk of major bleeding was higher than in younger patients, but similar in patients on OAC and in those on antiplatelet therapy or without antithrombotic treatment (4.0%/year versus 4.2%/year; P=0.77). OAC was overall associated with weighted net clinical benefit, assigning weights to nonfatal events according to their prognostic implication for subsequent death (−2.19%; CI, −4.23%, −0.15%; P=0.036). We found a significant gradient of this benefit as a function of age, with the oldest patients deriving the highest benefit. ConclusionsBecause the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of OAC is highest in very elderly patients, where it, by far, outweighs the risk of bleeding, with the greatest net clinical benefit in such patients.https://www.ahajournals.org/doi/10.1161/JAHA.117.005657anticoagulationatrial fibrillationmajor bleedingthromboembolic eventsvery elderly |
| spellingShingle | Giuseppe Patti Markus Lucerna Ladislav Pecen Jolanta M. Siller‐Matula Ilaria Cavallari Paulus Kirchhof Raffaele De Caterina Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation) Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anticoagulation atrial fibrillation major bleeding thromboembolic events very elderly |
| title | Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation) |
| title_full | Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation) |
| title_fullStr | Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation) |
| title_full_unstemmed | Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation) |
| title_short | Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub‐Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation) |
| title_sort | thromboembolic risk bleeding outcomes and effect of different antithrombotic strategies in very elderly patients with atrial fibrillation a sub analysis from the prefer in af prevention of thromboembolic events european registry in atrial fibrillation |
| topic | anticoagulation atrial fibrillation major bleeding thromboembolic events very elderly |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.005657 |
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