Very low-intensity anticoagulant therapy in elderly cardioembolic stroke patients with nonvalvular atrial fibrillation

Several investigations revealed the significant effect of anticoagulant therapy for stroke prevention in patients with atrial fibrillation. However, in the elderly population, the optimal therapeutic strategy of secondary prevention of cardioembolic stroke is still controversial. We prospectively evaluated the efficacy and safety of very low-intensity anticoagulant therapy (target range, Thrombotest = 20-30%: INR = 1.47-1.81) for elderly cardioembolic stroke patients due to nonvalvular atrial fibrillation. Twenty cardioembolic stroke patients (average age 80.0) with nonvalvular atrial fibrillation were included in our study. Anticoagulant therapy began 5 of 7 days after the embolic event. The incidental rate of ischemic stroke recurrence and bleeding complication were evaluated. During mean follow-up of 14.7 month, the annual recurrent rate of ischemic stroke was 8.2% (cardioembolic stroke = 4.1%/year, atherothrombotic stroke = 0%/year, lacunar stroke = 4.1%/year), whereas one non-fatal gastrointestinal bleeding was observed. Our study suggested that even in the elderly population, very low-intensity anticoagulant therapy may be effective, and safe with respect to prevention of bleeding complications, for secondary cardioembolic stroke prevention.