Physicians' attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation

Abstract Background Stroke prevention in elderly patients with atrial fibrillation (AF) can be challenging. Comparisons of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in the elderly, at different age strata (age 65–74, 75–89, ≥90) in the daily practice have not been well described, particularly in Asians. We aimed to assess the clinical outcomes of NOACs compared warfarin for stroke prevention in elderly patients with AF. Methods A total of 64,169 AF patients aged ≥65 years receiving NOACs or warfarin prescription were identified from the Taiwan National Health Insurance Research Database. The risks of adverse events were compared between NOACs and warfarin in all patients age ≥65 and specifically, with different age strata; that is 65–74 years, 75–89 years and >90 years. Results Overall NOACs were associated with a significantly lower risk of ischemic stroke (adjusted hazard ratio [aHR] 0.869, 95% confidence interval [CI] 0.812–0.931), ICH (aHR 0.524, 95% CI 0.456–0.601), major bleeding (aHR 0,824, 95% CI 0.776–0.875), mortality (aHR 0.511, 95% CI 0.491–0.532) and composite adverse events (aHR 0.646, 95% CI 0.625–0.667) compared to warfarin. There was heterogeneity in treatment effect for NOACs versus warfarin in different age strata, but the results still favored NOACs even among the very elderly (>90 years). The absolute risk difference and reductions in ICH and composite adverse events with NOAC use were even greater among the elderly compared to warfarin (Figure). Conclusions Compared to warfarin, NOACs were associated with a significantly lower risk of adverse events, with heterogeneity in treatment effects among different age strata. Overall, the clear safety signal in favor of NOACs over warfarin was evident irrespective of age strata, being most marked in the most elderly.

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CARDIOEMBOLIC STROKE IN LATVIA: PREVENTION AND LONG-TERM OUTCOME

CBU International Conference Proceedings ◽

10.12955/cbup.v4.821 ◽

2016 ◽

Vol 4 ◽

pp. 615-621

Author(s):

Elina Pucite ◽

Kristaps Jurjāns ◽

Evija Miglāne ◽

Baiba Luriņa ◽

Oskars Kalējs ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mortality Rate ◽

Secondary Prevention ◽

Patient Group ◽

Stroke Prevention ◽

Oral Anticoagulants ◽

Antiplatelet Agents ◽

Preventive Medication ◽

One Year

INTRODUCTION: Untreated non-valvular atrial fibrillation is one of major causes of stroke. The goal of the study was to evaluate the use of antithrombotic medication stroke prevention and assess long-term stroke outcome.METHODS: This study involved 531 cardio embolic stroke patients of the Paul’s Stradins Clinical University Hospital, Riga, Latvia, in 2014. After discharge the patients or their relatives were interviewed by phone after 30, 90, 180, and 365 days. Standardized questions were asked about the patients’ abilities and use of prescribed secondary prevention medication. The results were compared between patient groups, assigned according to prescribed medications.RESULTS: Of all the patients included in the study, 8.9% were using oral anticoagulants before stroke onset. One year after discharge, 1.44% of patients were not using any preventive medication, 23.56% were using antiplatelet agents, 43.27% warfarin, and 31.73% target-specific oral anticoagulants. The one-year mortality rate was 40.7%. The mortality rate was significantly higher in the patient group using no secondary preventive medication or antiplatelet agents compared to the patient group that used oral anticoagulants.CONCLUSION: Cardio embolic stroke primary and secondary prevention in Latvia is lacking. The study outcomes suggest that action is needed to increase the use of oral anticoagulants in primary stroke prevention in patients with atrial fibrillation. Poor function outcomes, dementia, and patients’ incompliance limits the use of oral anticoagulants in secondary prevention.

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Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Stroke ◽

10.1161/strokeaha.120.031827 ◽

2021 ◽

Vol 52 (4) ◽

pp. 1450-1454

Author(s):

Maurizio Paciaroni ◽

Giancarlo Agnelli ◽

Michela Giustozzi ◽

Valeria Caso ◽

Elisabetta Toso ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Intracerebral Hemorrhage ◽

Vitamin K ◽

Stroke Prevention ◽

Oral Anticoagulants ◽

Antiplatelet Agents ◽

Vitamin K Antagonist ◽

Logistic Regression Models ◽

Artery Disease

Background and Purpose: Clinical trials on stroke prevention in patients with atrial fibrillation have consistently shown clinical benefit from either warfarin or non–vitamin K antagonist oral anticoagulants (NOACs). NOAC-treated patients have consistently reported to be at lower risk for intracerebral hemorrhage (ICH) than warfarin-treated patients. The aims of this prospective, multicenter, multinational, unmatched, case-control study were (1) to investigate for risk factors that could predict ICH occurring in patients with atrial fibrillation during NOAC treatment and (2) to evaluate the role of CHA 2 DS 2 -VASc and HAS-BLED scores in the same setting. Methods: Cases were consecutive patients with atrial fibrillation who had ICH during NOAC treatment. Controls were consecutive patients with atrial fibrillation who did not have ICH during NOAC treatment. As within the CHA 2 DS 2 -VASc and HAS-BLED scores there are some risk factors in common, several multivariable logistic regression models were performed to identify independent prespecified predictors for ICH events. Results: Four hundred nineteen cases (mean age, 78.8±8.1 years) and 1526 controls (mean age, 76.0±10.3 years) were included in the study. From the different models performed, independent predictors of ICH were increasing age, concomitant use of antiplatelet agents, active malignancy, high risk of fall, hyperlipidemia, low clearance of creatinine, peripheral artery disease, and white matter changes. Low doses of NOACs (given according to label or not) and congestive heart failure were inversely associated with the risk of ICH. HAS-BLED and CHA 2 DS 2 -VASc scores performed poorly in predicting ICH with areas under the curves of 0.496 (95% CI, 0.468–0.525) and 0.530 (95% CI, 0.500–0.560), respectively. Conclusions: Several risk factors were associated to ICH in patients treated with NOACs for stroke prevention but not HAS-BLED and CHA 2 DS 2 -VASc scores.

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