Use of Oral Anticoagulant for Secondary Prevention of Stroke in Very Elderly Patients With Atrial Fibrillation: An Observational Study

Abstract

Background: Oral anticoagulant (OAC) is proven to be more effective than antiplatelet therapy in the secondary prevention of ischemic stroke in patients with atrial fibrillation (AF). The objective of this study was to determine the effect of age on the prescription of OAC and its actual use by neurologists for secondary prevention among the very elderly patients with AF hospitalized for ischemic stroke. Methods: In this prospective observational study, data from patients with first-ever ischemic stroke and AF were included. We reviewed the use of antithrombotic agents before stroke onset and at discharge in patients with AF who were aged 80 years or older. We analyzed the trends of oral anticoagulation as secondary prevention in very elderly patients and identify the reasons why anticoagulant was not prescribed at discharge. Results: A total of 152 patients with AF experienced first-ever ischemic stroke. Of these, 51 patients (33.6%) were ≥80 years of age, and 101 were <80 years of age. Thirteen patients died during the acute stroke and thus were excluded from the analysis. Of 139 ischemic stroke survivors at discharge, 45 were ≥80 years of age and 94 were <80 years of age. For those aged ≥80 years, 62.2% received neither antiplatelet nor anticoagulant agents before stroke onset. Surprisingly, only one patient (2.2%) was treated with OAC. At discharge, only 12 patients (26.7%) aged ≥80 years were treated with OAC compared with those aged <80 years (48/94 [51.1%]). Conclusion: This study suggests that OAC is underused in most of the very elderly patients despite its proven efficacy. A history of stroke did alter the trend of use of antithrombotic agents in this age group.

Keywords

• antithrombotic therapy
• very elderly
• anticoagulation
• atrial fibrillation
• stroke prevention