Anticoagulation in Elderly Patients with Atrial Fibrillation Authors

Carbone, Andreina; Bottino, Roberta; D’Andrea, Antonello; Golino, Paolo; Nigro, Gerardo; Russo, Vincenzo

doi:10.1007/978-3-030-74462-5_8

Andreina Carbone⁶,
Roberta Bottino⁶,
Antonello D’Andrea^7,8,
Paolo Golino⁶,
Gerardo Nigro⁶ &
…
Vincenzo Russo⁶

1047 Accesses

Abstract

Atrial fibrillation is the most common arrhythmia in clinical practice, and elderly patients are at higher risk of both ischemic and bleeding complications. Vitamin K antagonists (VKAs) reduce the risk of ischemic stroke in elderly with atrial fibrillation, but their use is associated with increased bleeding risk and require frequent international normalized ratio monitoring. Direct oral anticoagulants have emerged as alternatives to VKAs and are gradually increasing their popularity because of their fewer interactions and ease of use. Their effectiveness and safety have been well-established in the general population, but the benefit in the elderly is still unclear. This chapter aims to analyze the use of direct oral anticoagulant in elderly patients.

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References

Alnsasra H, Haim M, Senderey AB, Reges O, Leventer-Roberts M, Arnson Y, et al. Net clinical benefit of anticoagulant treatments in elderly patients with nonvalvular atrial fibrillation: experience from the real world. Heart Rhythm. 2019;16(1):31–7. https://doi.org/10.1016/j.hrthm.2018.08.016.
Article PubMed Google Scholar
Alonso A, Arenas de Larriva AP. Atrial fibrillation, cognitive decline and dementia. Eur Cardiol. 2016;11(1):49–53. PubMed PMID: 27547248; PubMed Central PMCID: PMC4988519. https://doi.org/10.15420/ecr.2016:13:2.
Article PubMed PubMed Central Google Scholar
AlTurki A, Marafi M, Russo V, Proietti R, Essebag V. Subclinical atrial fibrillation and risk of stroke: past, present and future. Medicina. 2019;55(10). PubMed PMID: 31547078; PubMed Central PMCID: PMC6843329. https://doi.org/10.3390/medicina55100611.
Andreotti F, Rocca B, Husted S, Ajjan RA, ten Berg J, Cattaneo M, et al. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on thrombosis. Eur Heart J. 2015;36(46):3238–49. https://doi.org/10.1093/eurheartj/ehv304.
Article CAS PubMed Google Scholar
Annoni G, Mazzola P. Real-world characteristics of hospitalized frail elderly patients with atrial fibrillation: can we improve the current prescription of anticoagulants? J Geriatr Cardiol. 2016;13(3):226–32. PubMed PMID: 27103917; PubMed Central PMCID: PMC4826892. https://doi.org/10.11909/j.issn.1671-5411.2016.03.010.
Article PubMed PubMed Central Google Scholar
Bahri O, Roca F, Lechani T, Druesne L, Jouanny P, Serot JM, et al. Underuse of oral anticoagulation for individuals with atrial fibrillation in a nursing home setting in France: comparisons of resident characteristics and physician attitude. J Am Geriatr Soc. 2015;63(1):71–6. https://doi.org/10.1111/jgs.13200.
Article PubMed Google Scholar
Bando S, Nishikado A, Hiura N, Ikeda S, Kakutani A, Yamamoto K, et al. Efficacy and safety of rivaroxaban in extreme elderly patients with atrial fibrillation: analysis of the Shikoku rivaroxaban registry trial (SRRT). J Cardiol. 2018;71(2):197–201. https://doi.org/10.1016/j.jjcc.2017.08.005.
Article PubMed Google Scholar
Banerjee A, Clementy N, Haguenoer K, Fauchier L, Lip GY. Prior history of falls and risk of outcomes in atrial fibrillation: the Loire Valley atrial fibrillation project. Am J Med. 2014;127(10):972–8. https://doi.org/10.1016/j.amjmed.2014.05.035.
Article PubMed Google Scholar
Biteker M, Basaran O, Dogan V, Altun I, Ozpamuk Karadeniz F, Tekkesin AI, et al. Real-world clinical characteristics and treatment patterns of individuals aged 80 and older with nonvalvular atrial fibrillation: results from the ReAl-life multicenter survey evaluating stroke study. J Am Geriatr Soc. 2017;65(8):1684–90. https://doi.org/10.1111/jgs.14855.
Article PubMed Google Scholar
By the American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society 2019 updated AGS beers criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–94. https://doi.org/10.1111/jgs.15767.
Article Google Scholar
Chao TF, Liu CJ, Lin YJ, Chang SL, Lo LW, Hu YF, et al. Oral anticoagulation in very elderly patients with atrial fibrillation: a nationwide cohort study. Circulation. 2018;138(1):37–47. https://doi.org/10.1161/CIRCULATIONAHA.117.031658.
Article PubMed Google Scholar
Chatap G, Giraud K, Vincent JP. Atrial fibrillation in the elderly: facts and management. Drugs Aging. 2002;19(11):819–46.
Article Google Scholar
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62. PubMed PMID: 23395245; PubMed Central PMCID: PMC4098658. https://doi.org/10.1016/S0140-6736(12)62167-9.
Article Google Scholar
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–92. https://doi.org/10.1111/j.1532-5415.2012.04054.x.
Article Google Scholar
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51. https://doi.org/10.1056/NEJMoa0905561.
Article CAS PubMed Google Scholar
Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364(9):806–17. https://doi.org/10.1056/NEJMoa1007432.
Article CAS PubMed Google Scholar
Deitelzweig S, Luo X, Gupta K, Trocio J, Mardekian J, Curtice T, et al. Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients. Curr Med Res Opin. 2017;33(10):1745–54. https://doi.org/10.1080/03007995.2017.1334638.
Article CAS PubMed Google Scholar
Diener HC, Aisenberg J, Ansell J, Atar D, Breithardt G, Eikelboom J, et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2. Eur Heart J. 2017;38(12):860–8. PubMed PMID: 26848150; PubMed Central PMCID: PMC5837363. https://doi.org/10.1093/eurheartj/ehw069.
Article CAS PubMed Google Scholar
Dietzel J, Haeusler KG, Endres M. Does atrial fibrillation cause cognitive decline and dementia? Europace. 2018;20(3):408–19. https://doi.org/10.1093/europace/eux031.
Article PubMed Google Scholar
Dillinger JG, Aleil B, Cheggour S, Benhamou Y, Bejot Y, Marechaux S, et al. Dosing issues with non-vitamin K antagonist oral anticoagulants for the treatment of non-valvular atrial fibrillation: why we should not underdose our patients. Arch Cardiovasc Dis. 2018;111(2):85–94. https://doi.org/10.1016/j.acvd.2017.04.008.
Article PubMed Google Scholar
Eikelboom JW, Wallentin L, Connolly SJ, Ezekowitz M, Healey JS, Oldgren J, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation. 2011;123(21):2363–72. https://doi.org/10.1161/CIRCULATIONAHA.110.004747.
Article CAS PubMed Google Scholar
Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. Eur Heart J. 2018;39(6):453–60. https://doi.org/10.1093/eurheartj/ehx579.
Article CAS PubMed Google Scholar
Fuster V, Ryden LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration with the North American Society of Pacing and Electrophysiology. Circulation. 2001;104(17):2118–50.
Article CAS Google Scholar
Gage BF, Boechler M, Doggette AL, Fortune G, Flaker GC, Rich MW, et al. Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Stroke. 2000;31(4):822–7. https://doi.org/10.1161/01.str.31.4.822.
Article CAS PubMed Google Scholar
Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093–104. https://doi.org/10.1056/NEJMoa1310907.
Article CAS PubMed Google Scholar
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA. 2001;285(18):2370–5.
Article CAS Google Scholar
Graham DJ, Reichman ME, Wernecke M, Zhang R, Southworth MR, Levenson M, et al. Cardiovascular, bleeding, and mortality risks in elderly Medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation. Circulation. 2015;131(2):157–64. https://doi.org/10.1161/CIRCULATIONAHA.114.012061.
Article CAS PubMed Google Scholar
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92. https://doi.org/10.1056/NEJMoa1107039.
Article CAS PubMed Google Scholar
Halperin JL, Hankey GJ, Wojdyla DM, Piccini JP, Lokhnygina Y, Patel MR, et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the rivaroxaban once daily, Oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET AF). Circulation. 2014;130(2):138–46. https://doi.org/10.1161/CIRCULATIONAHA.113.005008.
Article CAS PubMed Google Scholar
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42(5):373–498. https://doi.org/10.1093/eurheartj/ehaa612.
Article Google Scholar
Hylek EM, D’Antonio J, Evans-Molina C, Shea C, Henault LE, Regan S. Translating the results of randomized trials into clinical practice: the challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation. Stroke. 2006;37(4):1075–80. https://doi.org/10.1161/01.STR.0000209239.71702.ce.
Article PubMed Google Scholar
Investigators AWGotA, Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation Clopidogrel trial with Irbesartan for prevention of vascular events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367(9526):1903–12. https://doi.org/10.1016/S0140-6736(06)68845-4.
Article CAS Google Scholar
Investigators A, Connolly SJ, Pogue J, Hart RG, Hohnloser SH, Pfeffer M, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med. 2009;360(20):2066–78. https://doi.org/10.1056/NEJMoa0901301.
Article Google Scholar
January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199–267. PubMed PMID: 24682347; PubMed Central PMCID: PMC4676081. https://doi.org/10.1161/CIR.0000000000000041.
Article PubMed PubMed Central Google Scholar
Kato ET, Giugliano RP, Ruff CT, Koretsune Y, Yamashita T, Kiss RG, et al. Efficacy and safety of Edoxaban in elderly patients with atrial fibrillation in the ENGAGE AF-TIMI 48 trial. J Am Heart Assoc. 2016; 5(5). https://doi.org/10.1161/JAHA.116.003432.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):e1–e88. https://doi.org/10.1093/ejcts/ezw313.
Article PubMed Google Scholar
Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259–81. PubMed PMID: 25104492; PubMed Central PMCID: PMC4181351. https://doi.org/10.1016/S2214-109X(13)70089-5.
Article PubMed PubMed Central Google Scholar
Kuhn-Thiel AM, Weiss C, Wehling M, Members Faep. Consensus validation of the FORTA (fit fOR the aged) list: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31(2):131–40. PubMed PMID: 24353033; PubMed Central PMCID: PMC3907693. https://doi.org/10.1007/s40266-013-0146-0.
Article CAS PubMed Google Scholar
Kwon CH, Kim M, Kim J, Nam GB, Choi KJ, Kim YH. Real-world comparison of non-vitamin K antagonist oral anticoagulants and warfarin in Asian octogenarian patients with atrial fibrillation. J Geriatr Cardiol. 2016;13(7):566–72. PubMed PMID: 27605936; PubMed Central PMCID: PMC4996830. https://doi.org/10.11909/j.issn.1671-5411.2016.07.011.
Article CAS PubMed PubMed Central Google Scholar
Lauw MN, Eikelboom JW, Coppens M, Wallentin L, Yusuf S, Ezekowitz M, et al. Effects of dabigatran according to age in atrial fibrillation. Heart. 2017;103(13):1015–23. https://doi.org/10.1136/heartjnl-2016-310358.
Article CAS PubMed Google Scholar
Lee SR, Lee HJ, Choi EK, Han KD, Jung JH, Cha MJ, et al. Direct oral anticoagulants in patients with atrial fibrillation and liver disease. J Am Coll Cardiol. 2019;73(25):3295–308. https://doi.org/10.1016/j.jacc.2019.04.052.
Article CAS PubMed Google Scholar
Lefebvre MC, St-Onge M, Glazer-Cavanagh M, Bell L, Kha Nguyen JN, Viet-Quoc Nguyen P, et al. The effect of bleeding risk and frailty status on anticoagulation patterns in octogenarians with atrial fibrillation: the FRAIL-AF study. Can J Cardiol. 2016;32(2):169–76. https://doi.org/10.1016/j.cjca.2015.05.012.
Article PubMed Google Scholar
Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760–4.
Article CAS Google Scholar
Lip GY. The role of aspirin for stroke prevention in atrial fibrillation. Nat Rev Cardiol. 2011;8(10):602–6. https://doi.org/10.1038/nrcardio.2011.112.
Article CAS PubMed Google Scholar
Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest. 2010;137(2):263–72. https://doi.org/10.1378/chest.09-1584.
Article PubMed Google Scholar
Lip GY, Clemens A, Noack H, Ferreira J, Connolly SJ, Yusuf S. Patient outcomes using the European label for dabigatran. A post-hoc analysis from the RE-LY database. Thromb Haemost. 2014;111(5):933–42. https://doi.org/10.1160/TH13-09-0734.
Article CAS PubMed Google Scholar
Lip GY, Clementy N, Pericart L, Banerjee A, Fauchier L. Stroke and major bleeding risk in elderly patients aged >/=75 years with atrial fibrillation: the Loire Valley atrial fibrillation project. Stroke. 2015;46(1):143–50. https://doi.org/10.1161/STROKEAHA.114.007199.
Article PubMed Google Scholar
Man-Son-Hing M, Nichol G, Lau A, Laupacis A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med. 1999;159(7):677–85.
Article CAS Google Scholar
Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493–503. https://doi.org/10.1016/S0140-6736(07)61233-1.
Article CAS PubMed Google Scholar
Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119–25. https://doi.org/10.1161/CIRCULATIONAHA.105.595140.
Article Google Scholar
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322. https://doi.org/10.1161/CIR.0000000000000152.
Article PubMed Google Scholar
National Institute for Health and Care Excellence. NICE CG(180) atrial fibrillation (Update): the management of atrial fibrillation. Natl Institute Health Care Excel. 2014.
Google Scholar
Ng KH, Shestakovska O, Connolly SJ, Eikelboom JW, Avezum A, Diaz R, et al. Efficacy and safety of apixaban compared with aspirin in the elderly: a subgroup analysis from the AVERROES trial. Age Ageing. 2016;45(1):77–83. https://doi.org/10.1093/ageing/afv156.
Article PubMed Google Scholar
Nieuwlaat R, Olsson SB, Lip GY, Camm AJ, Breithardt G, Capucci A, et al. Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation. The euro heart survey on atrial fibrillation. Am Heart J. 2007;153(6):1006–12. https://doi.org/10.1016/j.ahj.2007.03.008.
Article CAS PubMed Google Scholar
O'Brien EC, Holmes DN, Ansell JE, Allen LA, Hylek E, Kowey PR, et al. Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF) registry. Am Heart J. 2014;167(4):601–9 e1. https://doi.org/10.1016/j.ahj.2013.12.014.
Article PubMed Google Scholar
Okumura K, Lip GYH, Akao M, Tanizawa K, Fukuzawa M, Abe K, et al. Edoxaban for the management of elderly Japanese patients with atrial fibrillation ineligible for standard oral anticoagulant therapies: rationale and design of the ELDERCARE-AF study. Am Heart J. 2017;194:99–106. https://doi.org/10.1016/j.ahj.2017.08.017.
Article CAS PubMed Google Scholar
Okumura K, Akao M, Yoshida T, Kawata M, Okazaki O, Akashi S, et al. Low-dose edoxaban in very elderly patients with atrial fibrillation. N Engl J Med. 2020;383:1735–45. https://doi.org/10.1056/NEJMoa2012883.
Article CAS PubMed Google Scholar
Oqab Z, Pournazari P, Sheldon RS. What is the impact of frailty on prescription of anticoagulation in elderly patients with atrial fibrillation? A systematic review and meta-analysis. J Atrial Fibrill. 2018;10(6):1870. PubMed PMID: 29988282; PubMed Central PMCID: PMC6009786. https://doi.org/10.4022/jafib.1870.
Article Google Scholar
Pastori D, Lip GYH, Farcomeni A, Del Sole F, Sciacqua A, Perticone F, et al. Incidence of bleeding in patients with atrial fibrillation and advanced liver fibrosis on treatment with vitamin K or non-vitamin K antagonist oral anticoagulants. Int J Cardiol. 2018;264:58–63. https://doi.org/10.1016/j.ijcard.2018.01.097.
Article PubMed Google Scholar
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91. https://doi.org/10.1056/NEJMoa1009638.
Article CAS PubMed Google Scholar
Pazan F, Weiss C, Wehling M, Forta. The FORTA (Fit fOR The Aged) List 2015: Update of a validated clinical tool for improved pharmacotherapy in the elderly. Drugs Aging. 2016;33(6):447–9. https://doi.org/10.1007/s40266-016-0371-4.
Article PubMed Google Scholar
Perera V, Bajorek BV, Matthews S, Hilmer SN. The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age Ageing. 2009;38(2):156–62. https://doi.org/10.1093/ageing/afn293.
Article PubMed Google Scholar
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the euro heart survey. Chest. 2010;138(5):1093–100. https://doi.org/10.1378/chest.10-0134.
Article PubMed Google Scholar
Proietti R, AlTurki A, Vio R, Licchelli L, Rivezzi F, Marafi M, et al. The association between atrial fibrillation and Alzheimer’s disease: fact or fallacy? A systematic review and meta-analysis. J Cardiovasc Med. 2020;21(2):106–12. https://doi.org/10.2459/JCM.0000000000000917.
Article Google Scholar
Rao MP, Vinereanu D, Wojdyla DM, Alexander JH, Atar D, Hylek EM, et al. Clinical outcomes and history of fall in patients with atrial fibrillation treated with oral anticoagulation: insights from the ARISTOTLE trial. Am J Med. 2018;131(3):269–75 e2. https://doi.org/10.1016/j.amjmed.2017.10.036.
Article PubMed Google Scholar
Rash A, Downes T, Portner R, Yeo WW, Morgan N, Channer KS. A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO). Age Ageing. 2007;36(2):151–6. https://doi.org/10.1093/ageing/afl129.
Article PubMed Google Scholar
Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62. https://doi.org/10.1016/S0140-6736(13)62343-0.
Article CAS PubMed Google Scholar
Russo V, Bianchi V, Cavallaro C, Vecchione F, De Vivo S, Santangelo L, et al. Efficacy and safety of dabigatran in a “real-life” population at high thromboembolic and hemorrhagic risk: data from MonaldiCare registry. Eur Rev Med Pharmacol Sci. 2015;19(20):3961–7.
CAS PubMed Google Scholar
Russo V, Rago A, D'Onofrio A, Nigro G. The clinical performance of dabigatran in the Italian real-life experience. J Cardiovasc Med. 2017a;18(11):922–3. https://doi.org/10.2459/JCM.0000000000000548.
Article Google Scholar
Russo V, Rago A, Proietti R, Di Meo F, Antonio Papa A, Calabro P, et al. Efficacy and safety of the target-specific oral anticoagulants for stroke prevention in atrial fibrillation: the real-life evidence. Therapeut Adv Drug Saf. 2017b;8(2):67–75. PubMed PMID: 28255434; PubMed Central PMCID: PMC5315223. https://doi.org/10.1177/2042098616673990.
Article CAS Google Scholar
Russo V, Attena E, Mazzone C, Melillo E, Rago A, Galasso G, et al. Real-life performance of edoxaban in elderly patients with atrial fibrillation: a multicenter propensity score-matched cohort study. Clin Ther. 2019a;41(8):1598–604. https://doi.org/10.1016/j.clinthera.2019.04.041.
Article CAS PubMed Google Scholar
Russo V, Carbone A, Rago A, Golino P, Nigro G. Direct oral anticoagulants in octogenarians with atrial fibrillation: it is never too late. J Cardiovasc Pharmacol. 2019b;73(4):207–14. https://doi.org/10.1097/FJC.0000000000000661.
Article CAS PubMed Google Scholar
Russo V, Rago A, Laezza N, Di Micco P, Giannetti L, Atripaldi L, et al. Edoxaban in elderly patient with morbid obesity and atrial fibrillation: the role of plasma levels evaluation for selecting the appropriate dose. Monaldi Archives for Chest Disease. 2020a; 90(1). https://doi.org/10.4081/monaldi.2020.1224.
Russo V, Attena E, Rago A, Melillo E, Di Micco P, Papa AA, et al. Clinical outcome of Edoxaban vs. vitamin K antagonists in patients with atrial fibrillation and diabetes mellitus: results from a multicenter, propensity-matched, real-world cohort study. J Clin Med. 2020b; 9(6). PubMed PMID: 32471222; PubMed Central PMCID: PMC7356851. https://doi.org/10.3390/jcm9061621.
Russo V, Attena E, Di Maio M, Mazzone C, Carbone A, Parisi V, et al. Clinical profile of direct oral anticoagulants versus vitamin K anticoagulants in octogenarians with atrial fibrillation: a multicentre propensity score matched real-world cohort study. J Thromb Thrombolysis. 2020c;49(1):42–53. https://doi.org/10.1007/s11239-019-01923-9.
Article CAS PubMed Google Scholar
Russo V, Attena E, Di Maio M, Carbone A, Parisi V, Rago A, et al. Non-vitamin K vs vitamin K oral anticoagulants in patients aged > 80 year with atrial fibrillation and low body weight. Eur J Clin Investig. 2020d:e13335. https://doi.org/10.1111/eci.13335.
Russo V, Vio R, Proietti R. Stroke, dementia, and atrial fibrillation: from pathophysiologic association to pharmacological implications. Medicina. 2020e;56(5):227. PubMed PMID: 32397581; PubMed Central PMCID: PMC7279210. https://doi.org/10.3390/medicina56050227.
Article PubMed Central Google Scholar
Sardar P, Chatterjee S, Chaudhari S, Lip GY. New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Geriatr Soc. 2014;62(5):857–64. https://doi.org/10.1111/jgs.12799.
Article PubMed Google Scholar
Shinohara M, Fujino T, Yao S, Yano K, Akitsu K, Koike H, et al. Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation. J Cardiol. 2018;73(1):7–13. https://doi.org/10.1016/j.jjcc.2018.05.012.
Article PubMed Google Scholar
Singh P, Arrevad PS, Peterson GM, Bereznicki LR. Evaluation of antithrombotic usage for atrial fibrillation in aged care facilities. J Clin Pharm Ther. 2011;36(2):166–71. https://doi.org/10.1111/j.1365-2710.2010.01167.x.
Article CAS PubMed Google Scholar
Siu CW, Tse HF. Net clinical benefit of warfarin therapy in elderly Chinese patients with atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7(2):300–6. https://doi.org/10.1161/CIRCEP.113.000858.
Article CAS PubMed Google Scholar
Sjalander S, Sjalander A, Svensson PJ, Friberg L. Atrial fibrillation patients do not benefit from acetylsalicylic acid. Europace. 2014;16(5):631–8. https://doi.org/10.1093/europace/eut333.
Article PubMed Google Scholar
Steffel J, Giugliano RP, Braunwald E, Murphy SA, Mercuri M, Choi Y, et al. Edoxaban versus warfarin in atrial fibrillation patients at risk of falling: ENGAGE AF-TIMI 48 analysis. J Am Coll Cardiol. 2016;68(11):1169–78. https://doi.org/10.1016/j.jacc.2016.06.034.
Article CAS PubMed Google Scholar
Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39(16):1330–93. https://doi.org/10.1093/eurheartj/ehy136.
Article CAS PubMed Google Scholar
Steinberg BA, Kim S, Piccini JP, Fonarow GC, Lopes RD, Thomas L, et al. Use and associated risks of concomitant aspirin therapy with oral anticoagulation in patients with atrial fibrillation: insights from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF) registry. Circulation. 2013;128(7):721–8. PubMed PMID: 23861512; PubMed Central PMCID: PMC3908483. https://doi.org/10.1161/CIRCULATIONAHA.113.002927.
Article CAS PubMed PubMed Central Google Scholar
Subic A, Cermakova P, Religa D, Han S, von Euler M, Kareholt I, et al. Treatment of atrial fibrillation in patients with dementia: a cohort study from the Swedish dementia registry. J Alzheimers Dis. 2018;61(3):1119–28. PubMed PMID: 29286925; PubMed Central PMCID: PMC5798527. https://doi.org/10.3233/JAD-170575.
Article CAS PubMed PubMed Central Google Scholar
Tulner LR, Van Campen JP, Kuper IM, Gijsen GJ, Koks CH, Mac Gillavry MR, et al. Reasons for undertreatment with oral anticoagulants in frail geriatric outpatients with atrial fibrillation: a prospective, descriptive study. Drugs Aging. 2010;27(1):39–50. https://doi.org/10.2165/11319540-000000000-00000.
Article PubMed Google Scholar
Verdecchia P, D’Onofrio A, Russo V, Fedele F, Adamo F, Benedetti G, et al. Persistence on apixaban in atrial fibrillation patients: a retrospective multicentre study. J Cardiovasc Med. 2019;20(2):66–73. https://doi.org/10.2459/JCM.0000000000000744.
Article CAS Google Scholar
Yao X, Abraham NS, Sangaralingham LR, Bellolio MF, McBane RD, Shah ND, et al. Effectiveness and safety of Dabigatran, Rivaroxaban, and Apixaban versus Warfarin in nonvalvular atrial fibrillation. J Am Heart Assoc. 2016;5(6). PubMed PMID: 27412905; PubMed Central PMCID: PMC4937291. https://doi.org/10.1161/JAHA.116.003725.
Zimetbaum PJ, Thosani A, Yu HT, Xiong Y, Lin J, Kothawala P, et al. Are atrial fibrillation patients receiving warfarin in accordance with stroke risk? Am J Med. 2010;123(5):446–53. https://doi.org/10.1016/j.amjmed.2009.11.015.
Article CAS PubMed Google Scholar

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Authors and Affiliations

Division of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy
Andreina Carbone, Roberta Bottino, Paolo Golino, Gerardo Nigro & Vincenzo Russo
Department of Cardiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
Antonello D’Andrea
Department of Cardiology, Umberto I hospital, Nocera Inferiore, Salerno, Italy
Antonello D’Andrea

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Andreina Carbone
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Roberta Bottino
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Antonello D’Andrea
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Paolo Golino
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Gerardo Nigro
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Vincenzo Russo
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Cardiac Rehabilitation Unit Ospedale, Sacra Famiglia Fatebenefratelli, Erba, Italy
Riccardo Proietti
McGill University, Montreal, QC, Canada
Ahmed AlTurki
Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padova, Italy
Nicola Ferri
Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli” - Monaldi Hospital, Naples, Italy
Vincenzo Russo
Division of Cardiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
T. Jared Bunch

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Carbone, A., Bottino, R., D’Andrea, A., Golino, P., Nigro, G., Russo, V. (2021). Anticoagulation in Elderly Patients with Atrial Fibrillation Authors. In: Proietti, R., AlTurki, A., Ferri, N., Russo, V., Bunch, T.J. (eds) Direct Oral Anticoagulants. Springer, Cham. https://doi.org/10.1007/978-3-030-74462-5_8

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DOI: https://doi.org/10.1007/978-3-030-74462-5_8
Published: 29 June 2021
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-74461-8
Online ISBN: 978-3-030-74462-5
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