Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events–European Registry in Atrial Fibrillation)

Journal of the American Heart Association

Volumn 6, Issue 7, 2017, Pages

  Patti, Giuseppe ^a   Lucerna, Markus ^b   Pecen, Ladislav ^c   Siller Matula, Jolanta M ^d   Cavallari, Ilaria ^a   Kirchhof, Paulus ^e,f   De Caterina, Raffaele ^g,h  

^a UNIVERSITY CAMPUS BIO MEDICO   (Italy)

^b DAIICHI SANKYO CO   (Japan)

^c INSTITUTE OF MATHEMATICS   (Czech Republic)

^d MEDICAL UNIVERSITY OF VIENNA   (Austria)

^e UNIVERSITY OF BIRMINGHAM   (United Kingdom)

^f UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST   (United Kingdom)

^g UNIVERSITY OF CHIETI   (Italy)

^h FONDAZIONE TOSCANA GABRIELE MONASTERIO   (Italy)

Author keywords

Anticoagulation; Atrial fibrillation; Major bleeding; Thromboembolic events; Very elderly

Indexed keywords

ANTICOAGULANT AGENT; ANTITHROMBOCYTIC AGENT; ANTIVITAMIN K; FIBRINOLYTIC AGENT;

AGED; ANTITHROMBOTIC ACTIVITY; ARTICLE; ATRIAL FIBRILLATION; BLEEDING RISK SCORE; CARDIOVASCULAR RISK; CAUSE OF DEATH; CEREBROVASCULAR ACCIDENT; CLINICAL OUTCOME; COHORT ANALYSIS; CONFIDENCE INTERVAL; CONTROLLED STUDY; FEMALE; FOLLOW UP; GERIATRIC PATIENT; GROUPS BY AGE; HUMAN; INCIDENCE; MAJOR CLINICAL STUDY; MALE; ODDS RATIO; RISK FACTOR; STATISTICAL ANALYSIS; STATISTICAL SIGNIFICANCE; THROMBOEMBOLISM; TRANSIENT ISCHEMIC ATTACK; VERY ELDERLY; WEIGHTED NET CLINICAL BENEFIT ANALYSIS; AGE; BLEEDING; CHEMICALLY INDUCED; CLINICAL DECISION MAKING; CLINICAL TRIAL; COMPARATIVE STUDY; COMPLICATION; EUROPE; MORTALITY; MULTICENTER STUDY; ORAL DRUG ADMINISTRATION; PATIENT SELECTION; REGISTER; RISK ASSESSMENT; TIME FACTOR; TREATMENT OUTCOME;

ADMINISTRATION, ORAL; AGE FACTORS; AGED; AGED, 80 AND OVER; ANTICOAGULANTS; ATRIAL FIBRILLATION; CLINICAL DECISION-MAKING; EUROPE; FEMALE; FIBRINOLYTIC AGENTS; HEMORRHAGE; HUMANS; INCIDENCE; ISCHEMIC ATTACK, TRANSIENT; MALE; PATIENT SELECTION; PLATELET AGGREGATION INHIBITORS; REGISTRIES; RISK ASSESSMENT; RISK FACTORS; STROKE; THROMBOEMBOLISM; TIME FACTORS; TREATMENT OUTCOME;

EID: 85045773070     PISSN: None     EISSN: 20479980     Source Type: Journal    
DOI: 10.1161/JAHA.117.005657     Document Type: Article

References (33)

1. National Population Projections 2010-Based Statistical Bulletin. London: Office for National Statistics; 2011. Available at: http://www.ons.gov.uk/ons/dc p171778_235886.pdf. Accessed November 1, 2016.
2. Andreotti F, Rocca B, Husted S, Ajjan RA, ten Berg J, Cattaneo M, Collet JP, De Caterina R, Fox KAA, Halvorsen S, Huber K, Hylek EM, Lip GYH, Montalescot G, Morais J, Patrono C, Verheugt FWA, Wallentin L, Weiss TW, Storey RF; on behalf of the ESC Thrombosis Working Group. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2015;36:3238–3249.
3. Marinigh R, Lip GYH, Fiotti N, Giansante C, Lane DA. Age as a risk factor for stroke in atrial fibrillation patients. J Am Coll Cardiol. 2010;56:827–837.
4. Edholm K, Ragle N, Rondina MT. Anti-thrombotic management of atrial fibrillation in the elderly. Med Clin North Am. 2015;99:417–430.
5. Mant J, Hobbs R, Fletcher K, Roalfe A, Fitzmaurice D, Lip GYH, Murray E. 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 randomized controlled trial. Lancet. 2007;370:493–503.
6. Ng KH, Shestakovska O, Connolly SJ, Eikelboom JW, Avezum A, Diaz R, Lanas F, Yusuf S, Hart RG. Efficacy and safety of apixaban compared with aspirin in the elderly: a subgroup analysis from the AVERROES trial. Age Ageing. 2016;45:77–83.
7. van Walraven C, Hart RG, Connolly SJ, Austin PC, Mant J, Hobbs R, Koudstaal PJ, Petersen P, Perez-Gomes F, Knottnerus JA, Boode B, Ezekowitz MD, Singer DE. Effect of age on stroke prevention therapy in patients with atrial fibrillation. Stroke. 2009;40:1410–1416.
8. Higuchi S, Kabeya Y, Matsushita K, Taguchi H, Ishiguro H, Kohshoh H, Yoshino H. Barthel index as a predictor of 1-year mortality in very elderly patients who underwent percutaneous coronary intervention for acute coronary syndrome: better activities of daily living, longer life. Clin Cardiol. 2016;39:83–89.
9. Dynina O, Vakili BA, Slater JN, Dynina O, Vakili BA, Slater JN, Sherman W, Ravi KL, Green SJ, Sanborn TA, Brown DL. In-hospital outcomes of contemporary percutaneous coronary interventions in the very elderly. Catheter Cardiovasc Interv. 2003;58:351–357.
10. Mizuno M, Kajimoto K, Sato N, Yumino D, Minami Y, Murai K, Munakata R, Asai K, Keida T, Sakata Y, Hagiwara N, Takano T; ATTEND Investigators. Clinical profile, management, and mortality in very-elderly patients hospitalized with acute decompensated heart failure: an analysis from the ATTEND registry. Eur J Intern Med. 2016;27:80–85.
11. Kirchhof P, Ammentorp B, Darius H, De Caterina R, Le Heuzey JY, Schilling RJ, Schmitt J, Zamorano JL. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events–European Registry in Atrial Fibrillation (PREFER in AF). Europace. 2014;16:6–14.
12. 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; ENGAGE AF-TIMI 48 Investigators. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093–2104.
13. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:2064–2089.
14. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ. 1980;58:113–130.
15. Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692–694.
16. Renda G, di Nicola M, De Caterina R. Net clinical benefit of non-vitamin K antagonist oral anticoagulant versus warfarin in phase III atrial fibrillation trials. Am J Med. 2015;128:1007–1014.
17. Eikelboom JW, Connolly SJ, Hart RG, Wallentin L, Reilly P, Oldgren J, Yang S, Yusuf S. Balancing the benefits and risks of 2 doses of dabigatran compared with warfarin in atrial fibrillation. J Am Coll Cardiol. 2013;62:900–908.
18. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. Circulation. 2012;126:2020–2035.
19. Kato ET, Giugliano RP, Ruff CT, Koretsune Y, Yamashita T, Kiss RG, Nordio F, Murphy SA, Kimura T, Jin J, Lanz H, Mercuri M, Braunwald E, Antman EM. Efficacy and safety of edoxaban in elderly patients with atrial fibrillation in the ENGAGE-TIMI 48 trial. J Am Heart Assoc. 2016;5:e003432. DOI: 10.1161/JAHA.116.003432.
20. Eikelboom JW, Wallentin L, Connolly SJ, Ezekowitz M, Healey JS, Oldgren J, Yang S, Alings M, Kaatz S, Hohnloser SH, Diener H-C, Franzosi MG, Huber K, Reilly P, Varrone J, Yusuf S. 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;123:2363–2372.
21. Halperin JL, Hankey GJ, Wojdyla DM, Piccini JP, Lokhnygina Y, Patel MR, Breithardt G, Singer DE, Becker RC, Hacke W, Paolini JF, Nessel CC, Mahaffey KW, Califf RM, Fox KAA. 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;130:138–146.
22. Halvorsen S, Atar D, Yang H, De Caterina R, Erol C, Garcia D, Granger CB, Hanna M, Held C, Husted S, Hylek EM, Jansky P, Lopes RD, Ruzyllo W, Thomas L, Wallentin L. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J. 2004;35:1864–1872.
23. Kooistra HA, Calf AH, Piersma-Wichers M, Kluin-Nelemans HC, Izaks GJ, Veeger NJ, Meijer K. Risk of bleeding and thrombosis in patients 70 years or older using vitamin K antagonists. JAMA Intern Med. 2016;176:1176–1183.
24. Wolff A, Shantsila E, Lip GYH, Lane DA. Impact of advanced age on management and prognosis in atrial fibrillation: insights from a population-based study in general practice. Age Ageing. 2015;44:874–878.
25. Brophy MT, Snyder KE, Gaehde S, Ives C, Gagnon D, Fiore LD. Anticoagu-lant use for atrial fibrillation in the elderly. J Am Geriatr Soc. 2004;52:1151– 1156.
26. Lip GYH, Laroche C, Dan G, Santini M, Kalarus Z, Rasmussen LH, Ioachim PM, Tica O, Boriani G, Cimaglia P, Diemberger I, Hellum CF, Mortensen B, Maggioni AP. ‘Real-world’ antithrombotic treatment in atrial fibrillation: the EORP-AF pilot survey. Am J Med. 2014;127:519–529.
27. Hanon O, Vidal JS, Pisica-Donose G, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Derumeaux G, Falissard B, Forette F, Pasquier F, Pinget M, Ourabah R, Becquemont L, Danchin N. Therapeutic management in ambulatory elderly patients with atrial fibrillation: the S.AGES cohort. J Nutr Health Aging. 2015;19:219–227.
28. Hanon O, Vidal J, Le Heuzey J, Kirchhof P, de Caterina R, Schmitt J, Laeis P, Mannucci PM, Marcucci M. Oral anticoagulant use in octogenarian European patients with atrial fibrillation: a subanalysis of PREFER in AF. Int J Cardiol. 2017;232:98–104.
29. 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;38:156–162.
30. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet. 1994;343:687–691.
31. Rash A, Downes T, Portner R, Yeo WW, Morgan N, Channer KS. A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenar-ians with atrial fibrillation (WASPO). Age Ageing. 2007;36:151–156.
32. Singer DE, Chang Y, Fang MC, Borowsky LH, Pomernacki NK, Udaltsova N, Go AS. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med. 2009;151:297–305.
33. 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;62:857–864.