To treat or not to treat very elderly naïve patients with atrial fibrillation with vitamin K antagonists (VKA): results from the VENPAF cohort

Internal and Emergency Medicine

Volumn 10, Issue 7, 2015, Pages 795-804

  Granziera, Serena ^a   Bertozzo, Giulia ^a   Pengo, Vittorio ^a   Marigo, Lucia ^a   Denas, Gentian ^a   Petruzzellis, Florinda ^a   Rossi, Katia ^a   Infante, Tiziana ^a   Padayattil, Seena Jose ^a   Perissinotto, Egle ^a   Manzato, Enzo ^a   Nante, Giovanni ^a  

^a UNIVERSITY OF PADOVA   (Italy)

Author keywords

Atrial fibrillation; Elderly; Major bleeding; Net clinical benefit; Oral anticoagulant treatment

Indexed keywords

ANTICOAGULANT AGENT; VITAMIN K GROUP; WARFARIN;

AGED; ANTAGONISTS AND INHIBITORS; ATRIAL FIBRILLATION; COHORT ANALYSIS; FEMALE; HUMAN; MALE; PSYCHOLOGY; RETROSPECTIVE STUDY; RISK FACTOR; THROMBOEMBOLISM; TREATMENT OUTCOME; VERY ELDERLY;

AGED; AGED, 80 AND OVER; ANTICOAGULANTS; ATRIAL FIBRILLATION; COHORT STUDIES; FEMALE; HUMANS; MALE; RETROSPECTIVE STUDIES; RISK FACTORS; THROMBOEMBOLISM; TREATMENT OUTCOME; VITAMIN K; WARFARIN;

EID: 84942986013     PISSN: 18280447     EISSN: 19709366     Source Type: Journal    
DOI: 10.1007/s11739-015-1236-2     Document Type: Article

References (44)

1. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, Guidelines-CPG ESCCfP, Document R (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation-developed with the special contribution of the European Heart Rhythm Association. Europace 14(10):1385–1413. doi:10.1093/europace/eus305
2. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, Stijnen T, Lip GY, Witteman JC (2006) Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 27(8):949–953. doi:10.1093/eurheartj/ehi825
3. Pengo V, Legnani C, Noventa F, Palareti G, Group IS (2001) Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding. A Multicenter Inception Cohort Study. Thromb Haemost 85(3):418–422
4. Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S (2007) Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 115(21):2689–2696. doi:10.1161/CIRCULATIONAHA.106.653048
5. Wittkowsky AK, Whitely KS, Devine EB, Nutescu E (2004) Effect of age on international normalized ratio at the time of major bleeding in patients treated with warfarin. Pharmacotherapy 24(5):600–605
6. Mant JW (2008) Pro: ‘Warfarin should be the drug of choice for thromboprophylaxis in elderly patients with atrial fibrillation’. Why warfarin should really be the drug of choice for stroke prevention in elderly patients with atrial fibrillation. Thromb Haemost 100(1):14–15. doi:10.1160/TH08-06-0344
7. Hylek EM (2008) Contra: ‘Warfarin should be the drug of choice for thromboprophylaxis in elderly patients with atrial fibrillation’. Caveats regarding use of oral anticoagulant therapy among elderly patients with atrial fibrillation. Thromb Haemost 100(1):16–17. doi:10.1160/TH08-06-0343
8. You JJ, Singer DE, Howard PA, Lane DA, Eckman MH, Fang MC, Hylek EM, Schulman S, Go AS, Hughes M, Spencer FA, Manning WJ, Halperin JL, Lip GY, American College of Chest P (2012) Antithrombotic therapy for atrial fibrillation: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e531S–e575S. doi:10.1378/chest.11-2304
9. European Heart Rhythm A, European Association for Cardio-Thoracic S, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH, Guidelines ESCCfP (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 12(10):1360–1420. doi:10.1093/europace/euq350
10. Friberg L, Hammar N, Ringh M, Pettersson H, Rosenqvist M (2006) Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Report from the Stockholm Cohort-study on Atrial Fibrillation (SCAF-study). Eur Heart J 27(16):1954–1964. doi:10.1093/eurheartj/ehl146
11. Hylek EM, D’Antonio J, Evans-Molina C, Shea C, Henault LE, Regan S (2006) Translating the results of randomized trials into clinical practice: the challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation. Stroke 37(4):1075–1080. doi:10.1161/01.STR.0000209239.71702.ce
12. Tsadok MA, Jackevicius C, Essebag V, Eisenberg M, Rahme E, Humphries K, Tu J, Pilote L (2013) Stroke and bleeding in older patients with atrial fibrillation treated with warfarin. J Am Coll Cardiol 61(10_S). doi:10.1016/S0735-1097(13)60372-1
13. Ansell J (2011) Bleeding in very old patients on vitamin K antagonist therapy. Circulation 124(7):769–771. doi:10.1161/CIRCULATIONAHA.111.043935
14. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G (2012) Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest J 141 (2_Suppl):e44S–e88S. doi:10.1378/chest.11-2292
15. Poli D, Antonucci E, Testa S, Tosetto A, Ageno W, Palareti G, Italian Federation of Anticoagulation C (2011) Bleeding risk in very old patients on vitamin K antagonist treatment: results of a prospective collaborative study on elderly patients followed by Italian Centres for Anticoagulation. Circulation 124(7):824–829. doi:10.1161/CIRCULATIONAHA.110.007864
16. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Ryden L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219. doi:10.1093/eurheartj/eht151
17. Authors/Task Force M, Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL, Guidelines ESCCfP, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schachinger V, Scheen A, Schirmer H, Stromberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG (2013) ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 34 (39):3035–3087. doi:10.1093/eurheartj/eht108
18. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Guidelines ESCCfP (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33(14):1787–1847. doi:10.1093/eurheartj/ehs104
19. Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabate M, Senior R, Taggart DP, van der Wall EE, Vrints CJ, Guidelines ESCCfP, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Ryden L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34 (38):2949–3003. doi:10.1093/eurheartj/eht296
20. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285(22):2864–2870
21. Rosendaal FR, Cannegieter SC, van der Meer FJ, Briet E (1993) A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 69(3):236–239
22. Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the S, Standardization Committee of the International Society on T, Haemostasis (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost: JTH 3(4):692–694. doi:10.1111/j.1538-7836.2005.01204.x
23. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY (2010) 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 138(5):1093–1100. doi:10.1378/chest.10-0134
24. Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146(12):857–867
25. Birocchi S, Cernuschi G, Podda GM, Costantino G (2013) To anticoagulate or not to anticoagulate? That is the question: a Medline-based quantitative approach to share evidence on common clinical problems. Intern Emerg Med 8(3):245–248. doi:10.1007/s11739-012-0816-7
26. Poli D, Antonucci E, Grifoni E, Abbate R, Gensini GF, Prisco D (2009) Bleeding risk during oral anticoagulation in atrial fibrillation patients older than 80 years. J Am Coll Cardiol 54(11):999–1002. doi:10.1016/j.jacc.2009.05.046
27. Copland M, Walker ID, Tait RC (2001) Oral anticoagulation and hemorrhagic complications in an elderly population with atrial fibrillation. Arch Intern Med 161(17):2125–2128
28. Naganuma M, Shiga T, Sato K, Murasaki K, Hashiguchi M, Mochizuki M, Hagiwara N (2012) Clinical outcome in Japanese elderly patients with non-valvular atrial fibrillation taking warfarin: a single-center observational study. Thromb Res 130(1):21–26. doi:10.1016/j.thromres.2011.11.005
29. Palareti G, Hirsh J, Legnani C, Manotti C, D’Angelo A, Pengo V, Moia M, Guazzaloca G, Musolesi S, Coccheri S (2000) Oral anticoagulation treatment in the elderly: a nested, prospective, case–control study. Arch Intern Med 160(4):470–478
30. De Berardis G, Lucisano G, D’Ettorre A, Pellegrini F, Lepore V, Tognoni G, Nicolucci A (2012) Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 307(21):2286–2294. doi:10.1001/jama.2012.5034
31. Peng YL, Leu HB, Luo JC, Huang CC, Hou MC, Lin HC, Lee FY (2013) Diabetes is an independent risk factor for peptic ulcer bleeding: a nationwide population-based cohort study. J Gastroenterol Hepatol 28(8):1295–1299. doi:10.1111/jgh.12190
32. Hernandez-Diaz S, Garcia Rodriguez LA (2006) Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications. BMC Med 4:22. doi:10.1186/1741-7015-4-22
33. Longstreth GF (1997) Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 92(3):419–424
34. Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW (2005) Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med 118(6):612–617. doi:10.1016/j.amjmed.2005.02.022
35. van Walraven C, Hart RG, Connolly S, Austin PC, Mant J, Hobbs FD, Koudstaal PJ, Petersen P, Perez-Gomez F, Knottnerus JA, Boode B, Ezekowitz MD, Singer DE (2009) Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators. Stroke 40(4):1410–1416. doi:10.1161/STROKEAHA.108.526988
36. Marinigh R, Lip GY, Fiotti N, Giansante C, Lane DA (2010) Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol 56(11):827–837. doi:10.1016/j.jacc.2010.05.028
37. Pengo V, Cucchini U, Denas G, Davidson BL, Marzot F, Jose SP, Iliceto S (2010) Lower versus standard intensity oral anticoagulant therapy (OAT) in elderly warfarin-experienced patients with non-valvular atrial fibrillation. Thromb Haemost 103(2):442–449. doi:10.1160/TH09-05-0311
38. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L, Committee R-LS, Investigators (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151. doi:10.1056/NEJMoa0905561
39. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM, Investigators RA (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365(10):883–891. doi:10.1056/NEJMoa1009638
40. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L, Committees A, Investigators (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365(11):981–992. doi:10.1056/NEJMoa1107039
41. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Spinar J, Ruzyllo W, Ruda M, Koretsune Y, Betcher J, Shi M, Grip LT, Patel SP, Patel I, Hanyok JJ, Mercuri M, Antman EM, Investigators EA-T (2013) Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 369(22):2093–2104. doi:10.1056/NEJMoa1310907
42. Coccheri S, Orlando D (2013) New oral anticoagulants in atrial fibrillation: a reappraisal of trial results looking at absolute figures. Intern Emerg Med 8(2):115–122. doi:10.1007/s11739-012-0886-6
43. Granziera S, Cohen AT, Nante G, Manzato E, Sergi G (2015) Thromboembolic prevention in frail elderly patients with atrial fibrillation: a practical algorithm. J Am Med Dir Assoc. doi:10.1016/j.jamda.2014.12.008
44. Harel Z, Sholzberg M, Shah PS, Pavenski K, Harel S, Wald R, Bell CM, Perl J (2014) Comparisons between novel oral anticoagulants and vitamin K antagonists in patients with CKD. J Am Soc Nephrol: JASN 25(3):431–442. doi:10.1681/ASN.2013040361