Oral anticoagulation in octogenarians with atrial fibrillation. (15th November 2016)

• Record Type: Journal Article
• Authors: Hugo, González Saldivar; Figueiras-Graillet, Lourdes M.; Anguita, Manuel; Marín, Francisco; Bertomeu, Vicente; Roldán, Inmaculada; Ruiz, Martín; Muñiz, Javier; Martínez-Sellés, Manuel
• Is Part Of: International journal of cardiology. Volume 223(2016)
• Page Start: 87
• Page End: 90
• Publication Date: 2016-11-15
• Subjects: Atrial fibrillation -- Time in therapeutic range -- Vitamin K antagonists -- Age -- Octogenarians; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.08.004
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Vitamin K antagonists (VKAs) are still largely employed, even in nonvalvular atrial fibrillation (AF). Our aim was to study the clinical profile of octogenarians treated with oral anticoagulation and to study the effect of age on the quality of VKAs anticoagulation. Methods: Data are from a prospective national registry in an adult Spanish population of nonvalvular AF. We included 1637 patients who had been receiving VKAs for at least 6 months before enrolment. Results: Mean age was 73.8 ± 9.4 years. Patients aged > 80 years (N = 429) had a high risk profile with higher risk of stroke and bleeding than younger patients; CHA2 DS2 -VASc (Cardiac failure, Hypertension, Age > 74, Diabetes, Stroke, Vascular disease, Age 65–74 years, and Sex category) 4.5 ± 1.3 vs. 3.5 ± 1.6, p < 0.001, HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 64 years), Drugs/alcohol concomitantly) 2.4 ± 0.9 vs. 1.9 ± 1.1, p < 0.001. Creatinine clearance was lower in octogenarians than in younger patients (54.3 ± 16.1 ml/min vs. 69.5 ± 23.7 ml/min, p < 0.001) and severe renal disease with creatinine clearance < 30 ml/min was more frequent in octogenarians (5.2% vs. 2.2%, p < 0.001). In patients treated with VKAs (N = 1637), the international normalized ratio values of the 6 months previous to enrollment were similar in all age quartiles, as was the time in the therapeutic range. Conclusion: In this large registry octogenarians with nonvalvular AF had high risk of stroke and bleeding and frequent renal disease. VKAs anticoagulation quality was similar in octogenarians and in younger patients. Graphical abstract: Main differences in baseline characteristics between the first three quartiles and octogenarians.Image 1 Highlights: Octogenarians with nonvalvular AF have a high risk of stroke. They also present a high risk of bleeding and frequent renal disease. VKAs anticoagulation quality is similar in octogenarians and in younger patients.