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Oral anticoagulation patterns and prognosis in octogenarian patients with atrial fibrillation

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Abstract

The relationship between oral anticoagulants (OACs) and prognosis in elderly patients with atrial fibrillation (AF) has not been adequately explored. In this retrospective cohort study, we identified subjects aged over 80 from a database of 1140 AF patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018. We examined the OAC treatment of octogenarian patients at discharge [VKA (vitamin K antagonist), NOAC (non-vitamin K antagonist oral anticoagulant), no OAC treatment]. We analyzed follow-up data of patients on OAC at discharge. The primary endpoint was all-cause death. The secondary endpoint was the incidence of stroke and major bleeding. The association of NOAC versus VKA treatment with these endpoints was assessed with multivariable Cox regression, using the VKA group as reference. A total of 330 octogenarian patients with AF were included with a mean (± SD) age of 83.9 ± 3.5 years. At discharge, 53.3% received a NOAC, 30% a VKA, and 16.7% no OAC. Patients on OAC were followed-up over a median of 2.6-years . The adjusted risk of all-cause death was not different in the NOAC group, compared with the VKA group (hazard ratio [HR], 0.72; 95% confidence intervals [CI] 0.50–1.03; P = 0.07). The risk of stroke or major bleeding was not different either (all P > 0.05). In conclusion, in this cohort of post-discharge octogenarian patients with AF, the risk for all-cause death was similar in NOAC versus VKA users, after adjustment for baseline covariates. No differences in stroke and major bleeding events among these treatment groups were revealed.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AF:

Atrial fibrillation

CHA2DS2VASc:

Congestive heart failure, hypertension, aged ≥ 75, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, aged 65–74, sex category

CI:

Confidence interval

HAS-BLED:

Hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly (> 65), drugs or alcohol

HR:

Hazard ratio

MISOAC-AF:

Motivational interviewing to support oral anticoagulation adherence in patients with non-valvular atrial fibrillation

LAVi:

Left atrial volume index

NOAC:

Non-vitamin K antagonist oral anticoagulant

OAC:

Oral anticoagulants

VKA:

Vitamin K antagonist

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Acknowledgements

We want to acknowledge Dimitra Vasdeki, George Dividis, George Fotos, Eleni Paschou, Evropi Forozidou, Paraskevi Tsoukra, Eleni Kotsi, Ioannis Goulas, who contributed in data collection during the conduction of the MISOAC-AF trial.

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Authors and Affiliations

  1. First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece

    Anastasios Papanastasiou, Anastasios Kartas, Athanasios Samaras, Eleni Vrana, Andreas Papazoglou, Dimitrios V. Moysidis, Amalia Baroutidou, Michail Botis, Evaggelos Liampas, Ioannis Vouloagkas, Efstratios Karagiannidis, Haralambos Karvounis, Apostolos Tzikas & George Giannakoulas

  2. Interbalkan European Medical Center, Asklipiou 10, Pylaia, Thessaloniki, Greece

    Apostolos Tzikas

  3. 2nd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Evangelia Mareti

Authors
  1. Anastasios Papanastasiou
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  15. George Giannakoulas
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Corresponding author

Correspondence to George Giannakoulas.

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Conflict of interests

The authors declare that they have no conflict of interests.

Ethical approval

Ethical approval was waived by the Aristotle University Ethics Committee in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. The MISOAC-AF trial from which the present sub-study derived, received approval from the Aristotle University Ethics Committee and its procedures were performed with the principles of Good Clinical Practice and the Declaration of Helsinki.

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A freely-given, informed consent to participate in the MISOAC-AF trial was obtained from all participants.

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Papanastasiou, A., Kartas, A., Samaras, A. et al. Oral anticoagulation patterns and prognosis in octogenarian patients with atrial fibrillation. J Thromb Thrombolysis 53, 851–860 (2022). https://doi.org/10.1007/s11239-021-02571-8

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