English Polski
Vol 19 (2024): Continuous Publishing
Original paper
Published online: 2023-11-16

open access

Page views 874
Article views/downloads 134
Get Citation

Connect on Social Media

Connect on Social Media

Antithrombotic therapy in elderly patients with atrial fibrillation: an analysis of non-treatment predisposing factors - results from the Polish Atrial Fibrillation (POL-AF) registry.

Agnieszka Ciba-Stemplewska12, Iwona Gorczyca-Głowacka3, Olga Jelonek34, Beata Uziębło-Życzkowska5, Małgorzata Maciorowska5, Maciej Wójcik6, Robert Błaszczyk6, Agnieszka Kapłon-Cieślicka7, Monika Gawałko789, Renata Rajtar-Salwa10, Tomasz Tokarek1112, Jacek Bil13, Michał Wojewódzki13, Anna Szpotowicz14, Małgorzata Krzciuk14, Janusz Bednarski1516, Elwira Bakuła-Ostalska15, Anna Tomaszuk-Kazberuk17, Anna Szyszkowska17, Marcin Wełnicki18, Artur Mamcarz18, Beata Wożakowska-Kapłon34
DOI: 10.5603/fc.97374

Abstract

Introduction. The elderly age is associated with numerous comorbidities. Benefits of antithrombotic treatment regarding the prevention of stroke in patients aged ≥ 75 were demonstrated in most studies. The studies were undertaken due to elderly patients being underrepresented in randomized controlled trials. The aim of this study was to assess the prevalence of oral anticoagulant (OAC) therapy in patients aged ≥ 75 and to identify factors that predispose patients in this group for discontinuation of treatment.

Methods. The study was based on the multicenter prospective Polish Atrial Fibrillation (POL-AF) registry including patients from 10 cardiology centres in Poland. Recruitment lasted from 1 January 2019 to 1 December 2019. Included and analyzed in the study were patients aged ≥ 75 years.

Results. The study group consisted of 1731 patients, with 1563 (90.3%) patients receiving OACs, 71 (4.1%) patients receiving antiplatelets drug, 54 (3.1%) patients receiving low molecular weight heparin, and 43 (2.5%) patients not receiving any stroke prevention. The mean age was 82.2 (5.0) years. Univariable logistic regression models were developed for the choice of OAC versus no treatment. On this basis, specific predictors for the choice of OAC treatment were selected for including in the multivariable model. Independent predictors of no OAC prescription were: anaemia (odds ratio [OR] 0.14, 95% CI: 0.06–0.35, p < 0.001), history of bleeding (OR 0.26, 95% CI: 0.14–0.5, p < 0.001), renal dysfunction (OR 0.42, 95% CI 0.27–0.67, p < 0.001), cancer (OR 0.54, 95% CI: 0.3–0.97, p = 0.04), and age (OR 0.79, 95% CI 0.67–0.94, p = 0.006).

Conclusions. Most elderly AF patients received OACs. The factors predisposing to non-use of OACs in these patients included conditions which significantly increased the risk of bleeding complications.

Article available in PDF format

View PDF Download PDF file

References

  1. Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the european society of cardiology (ESC) developed with the special contribution of the european heart rhythm association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373–498.
  2. Jani BD, Nicholl BI, McQueenie R, et al. Multimorbidity and co-morbidity in atrial fibrillation and effects on survival: findings from UK Biobank cohort. Europace. 2018; 20(FI_3): f329–f336.
  3. Staerk L, Sherer JA, Ko D, et al. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ Res. 2017; 120(9): 1501–1517.
  4. Gorczyca I, Jelonek O, Michalska A, et al. Stroke prevention and guideline adherent antithrombotic treatment in elderly patients with atrial fibrillation: A real-world experience. Medicine (Baltimore). 2020; 99(29): e21209.
  5. Mazurek M, Halperin JL, Huisman MV, et al. Antithrombotic treatment for newly diagnosed atrial fibrillation in relation to patient age: the GLORIA-AF registry programme. Europace. 2020; 22(1): 47–57.
  6. Virdone S, Himmelreich J, Pieper KS, et al. Comparative effectiveness of NOAC vs VKA in patients representing common clinical challenges: results from the GARFIELD-AF registry. European Heart Journal. 2021; 42(Supplement_1).
  7. Mitchell A, Snowball J, Welsh TJ, et al. Prescribing of direct oral anticoagulants and warfarin to older people with atrial fibrillation in UK general practice: a cohort study. BMC Med. 2021; 19(1): 189.
  8. Boriani G, Proietti M, Laroche C, et al. P3475Relationship between age and use of oral anticoagulant drugs in european atrial fibrillation patients: the EORP-AF general long-term registry. European Heart Journal. 2018; 39(suppl_1).
  9. Hutchens R, Hung J, Briffa T, et al. Antithrombotic Therapy in Atrial Fibrillation Management in Western Australia: Temporal Trends and Evidence-Treatment Gaps. Heart Lung Circ. 2021; 30(7): 955–962.
  10. Márquez MF, Baños-González MA, Guevara-Valdivia ME, et al. CARMEN-AF Committees and Investigators. Gender differences and management of stroke risk of nonvalvular atrial fibrillation in an upper middle-income country: Insights from the CARMEN-AF registry. Int J Cardiol Heart Vasc. 2019; 22(1): 117–122.
  11. Mitchell A, Watson MC, Welsh T, et al. Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies. J Clin Med. 2019; 8(4).
  12. Haas S, Camm AJ, Bassand JP, et al. GARFIELD-AF Investigators. Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF. Am Heart J. 2019; 213: 35–46.
  13. Bassand JP, Accetta G, Al Mahmeed W, et al. GARFIELD-AF Investigators. Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation. PLoS One. 2018; 13(1): e0191592.
  14. Ehrlinder H, Orsini N, Modig K, et al. Clinical characteristics and antithrombotic prescription in elderly hospitalized atrial fibrillation patients: A cross-sectional analysis of a Swedish single-center clinical cohort. Int J Cardiol Heart Vasc. 2020; 27: 100505.
  15. Grymonprez M, Steurbaut S, De Backer TL, et al. Effectiveness and Safety of Oral Anticoagulants in Older Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis. Front Pharmacol. 2020; 11: 583311.
  16. Wojszel ZB, Kasiukiewicz A. Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study. J Thromb Thrombolysis. 2020; 49(1): 18–26.
  17. Ramírez SG, Sevilla ÁR, Gómez MM. Anaemia in the elderly. Medicina Clínica (English Edition). 2017; 149(11): 496–503.
  18. Fradley MG, Ellenberg K, Alomar M, et al. Patterns of Anticoagulation Use in Patients With Cancer With Atrial Fibrillation and/or Atrial Flutter. JACC CardioOncol. 2020; 2(5): 747–754.
  19. Undas A, Drabik L, Potpara T, et al. Non-vitamin K antagonist oral anticoagulants (NOACs) in cancer patients with atrial fibrillation. Anatol J Cardiol. 2020; 23(1): 10–18.
  20. Rondano E, Bertolazzi M, Galluzzo A, et al. Effectiveness and safety of antithrombotic strategies in elderly patients with acute myocardial infarction. World J Cardiol. 2020; 12(11): 513–525.