Safety and efficacy analysis of oral anticoagulants in elderly patients with atrial fibrillation aged 90 and older

Objective To explore efficacy and safety of oral anticoagulants in elderly patients with atrial fibrillation (AF) aged 90 years and older. Methods A total of 125 AF patients who undergone anticoagulant therapy from January 2014 to November 2017 in the department of Cardiology and Neurology of the First Affiliated Hospital of Soochow University were enrolled. They were divided into two groups according to drug type: vitamin K antagonist warfarin - the VKA group (n=54) and non-vitamin K antagonist oral anticoagulant (NOAC) dabigatran and rivaroxaban - the NOAC group (n=71). The follow-up time was (14.0±5.2) months, the primary endpoint events included ischemic stroke/transient ischemic attack (TIA) and systemic embolism (SE), major bleeding (MB). The secondary endpoints included anticoagulant discontinuation and all-cause death. Results Of the 125 patients, 54 were in the warfarin group and 71 in the NOAC group. The primary endpoints: 7 ischemic events and 14 major bleeding events. Secondary endpoints: 36 discontinuations and 19 all-cause deaths. Competitive risk survival analysis by R software showed that previous ischaemic stroke/TIA (SHR=3.47, 95%CI: 1.94-7.51, P=0.008), vascular disease (SHR=2.89, 95%CI: 1.27-6.60, P=0.012), CHA2DS2-VASc≥2 (SHR=3.54, 95%CI: 0.46-7.60, P=0.048) were independent predictors of ischaemic stroke/TIA/SE. Previous bleeding (SHR=4.53, 95%CI: 1.37-4.64, P=0.002), HAS-BLED≥3 (SHR=5.65, 95%CI: 0.76-6.71, P=0.005) were independent predictors of major bleeding in this study. Conclusions Oral anticoagulants in elderly patients with atrial fibrillation over 90 years old is safe and effective. Patients with previous ischemic events, history of vascular disease, and the characteristic of CHA2DS2-VASc≥2 are more likely to develop ischemic events, patients with a history of bleeding and HAS-BLED≥3 points are more likely to have a bleeding event. Key words: Atrial fibrillation; Anticoagulants; Aged, 90 and over