Clinical Interventions in Aging (Mar 2015)
Antithrombotic therapy in elderly patients with non-valvular atrial fibrillation: a pilot study
Abstract
Wei Xiang, Jingwei Zhang, Meilin Liu, Fang Liu, Xueru Feng, Yuchuan Wang Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China Objective: Non-valvular atrial fibrillation (NVAF) is one common arrhythmia in the elderly. However, use of antithrombotic therapy in this population is not well known in the People’s Republic of China. This study aimed at investigating antithrombotic therapy status in elderly patients with NVAF in our hospital.Methods: A cross-sectional study of consecutive geriatric patients aged ≥60 years with NVAF who discharged from our hospital between January 2012 and December 2013 were collected. CHA2DS2-VASc score (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes, stroke or transient ischemic attack [doubled], vascular disease, age 65–74, and sex category [female]) was used to analyze antithrombotic indication.Results: We consecutively collected data of 1,000 discharged elderly patients (≥60 years) with NVAF (mean age 75.3±8.0 years, 75 years or older 54.7%, female 42.7%). The proportion of paroxysmal atrial fibrillation and non-paroxysmal atrial fibrillation (persistent or permanent) patients were 39.4% and 60.6%, respectively. Among 1,000 patients, 29.1% received oral anticoagulant therapy (OAT), including warfarin (27.8%) and novel oral anticoagulants (1.3%), 39.5% of patients received antiplatelet therapy, and 31.4% received neither therapy. Based on CHA2DS2-VASc score for stroke risk stratification, 68.9% patients with score ≥1 and 70.2% patients with score ≥2 received antithrombotic therapy, while the rates of OAT were 29.1% and 29.5%, respectively. Among patients with high stroke risk, those with paroxysmal atrial fibrillation were less likely to receive OAT compared with the patients with non-paroxysmal atrial fibrillation (19.5% vs 35.7%, P<0.001). The patients ≥75 years old had lower rate of OAT than the patients <75 years old (25.8% vs 34.8%, P=0.003). The patients with coronary artery disease had lower rate of OAT than the patients without coronary artery disease (24.4% vs 33.4%, P=0.003). Sex and history of stroke or transient ischemic attack had no effect on the use of OAT (30.8% vs 27.9%, P=0.326 and 28.8% vs 29.8%, P=0.761, respectively).Conclusion: OAT in elderly patients with NVAF in our hospital is underused, especially in those patients with higher risk of stroke. Keywords: elderly, atrial fibrillation, ischemic stroke, anticoagulation, CHA2DS2-VASc score
