Patients aged 90 years or older with atrial fibrillation treated with oral anticoagulants: A multicentre observational study

Background: Patients aged 90 years or older are often excluded from or under-represented in clinical trials and cohort studies. The clinical benefit of anticoagulation in nonagenarians with atrial fibrillation (AU) remains undefined. Objeciives: To assess the effectiveness and safely of oral anticoagulants in AF patients aged 90 years or older. Methods: Non-valvular AF patients aged 90 years or older receiving direct oral anticoagulants (DOACs) Of vitamin K antagonists (VKAs) were included in this observational multicentre study.The primary outcome was the composite of ischaemic stroke/transient ischemic attack (TA) and systemic embolism (SE). Major bleeding (MB), anticoagulant discontinuation and all-cause death were also assessed. Results are reported as sub-distribution hazard ratios (SHR) with 95% CI, taking death as competing risk. Results: 546 patients were included (301 VKAs retrospective cohort and 245 DOACs prospective cohort; median follow-up 404 days). The rate of ischaemic stroke/TIA/SE was 2.4% patient-year and that of MB 5.5% patient-year. Previous ischaemic stroke/TIA (SHR 3.47; 95% Cl 1.54-7.81) and vascular disease (SHR 2.89; 95% CII27-6.60) were independent predictors of ischaemic stroke/TIA/SE. Previous bleeding (SHR 2.53; 95% (11.37-4.64) was an independent predictor of MB. The risk of ischaemic stroke/TIA/SE (SHR 0.78, 95' Cl 0.30-2.04) or MB (SHR 1.43, 95% Cl 0.77-2.65) was not significantly different with DOACs or VKAs. Conclusions: In Al nonagenarians receiving anticoagulant treatment, the rate of ischaemic stroke/TA/SE is relalively low with the drawback of a not negligible rate of MB. DOACs seem a reasonable option for prevention of ischaemic stroke/T1A/SE in this setting. Crown Copyright (C) 2019 Published by Elsevier B.V. All rights reserved.