Long-term anticoagulation is a safe stroke prevention strategy for atrial fibrillation (AFib) patients 90 years old and older, according to new findings published in the American Journal of Cardiology.
“The safety and effectiveness of anticoagulation among nonagenarians are poorly understood, since these patients were underrepresented in the pivotal trials of AC,” wrote lead author Ahmed Elkaryoni, MD, division of cardiovascular disease at Loyola University Medical Center in Maywood, Illinois, and colleagues. “While age is an independent risk factor for stroke in patients with AF, the net clinical benefit of anticoagulation may be mitigated by an increased risk of bleeding.”
Elkaryoni’s team explored data from the Nationwide Readmission Database from 2010 to 2015. More than 840,000 AFib patients being treated with long-term anticoagulation were separated into two groups: those who were younger than 90 years old and those who were 90 years old or older. The nonagenarian group included more than 77,000 patients.
Patients with other indications for anticoagulation therapy other than AFib were excluded from this particular study.
Overall, the all-cause readmission rate after six months for patients ≥90 years old (34.1%) was similar to the rate for all other adult patients (34.8%). After propensity score matching, the all-cause readmission rates after six months were 34.1% for patients ≥90 years old and 35% for all other adult patients. The six-month readmission rate for acute ischemic stroke/transient ischemic attack, however, was slightly higher for these patients—1.6% compared to 1%.
Also, the rates of intracranial hemorrhage were the same for both patient groups.
Elkaryoni et al. described these findings as “reassuring,” though they did emphasize that data related to out-of-hospital mortality was not available.
The full study is available here.