Antithrombotic therapy in elderly patients with atrial fibrillation: effects and bleeding complications: a stratified analysis of the NASPEAF randomized trial.
OBJECTIVE
Atrial fibrillation patients with prior embolism have a high risk of vascular events in spite of anticoagulant therapy and elderly patients carry an additional risk. We analysed and compared vascular events-rate between older and younger than 75 years atrial fibrillation patients randomized to anticoagulant-alone or combined antiplatelet plus moderate-level anticoagulant therapy.


RESULTS
A total of 967 patients stratified by age and the history of prior embolism were randomized to therapeutic doses of anticoagulant-alone or combined antithrombotic therapy. Primary events were fatal and non-fatal ischaemic or haemorrhagic stroke/transient ischaemic attack, systemic embolism and myocardial infarction, sudden death and death from bleeding. The elderly, compared with the younger patients, had higher event-rate [hazard ratio 2.31 (95% confidence interval 1.37-3.90), P < 0.003]. The elderly suffered higher severe bleeding event-rate during anticoagulant therapy. The combined, compared with the anticoagulant therapy, reduced the vascular events-rate in the elderly (P = 0.012) and caused less intracranial haemorrhages and less bleeding mortality, although more non-fatal gastric bleeding.


CONCLUSIONS
The elderly with AF had a higher event-rate than the younger patients. A higher severe bleeding event-rate was also registered in elderly patients receiving anticoagulant therapy. Combined, compared with anticoagulant therapy, significantly reduced vascular events and bleeding mortality in elderly patients.
Pérez-Gómez
Francisco
F
Section of Cardiology, Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain. fperezg.hcsc@salud.madrid.org
Iriarte
Jose A
JA
Zumalde
Javier
J
Berjón
Jesus
J
Salvador
Antonio
A
Alegría
Eduardo
E
Maluenda
María P
MP
Asenjo
Susana
S
Perez-Saldaña
Rosario
R
de la Torre
Ricardo Gómez
RG
Bover
Ramón
R
Fernández
Cristina
C
D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004338:Drug Combinations; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016019:Survival Analysis; D016896:Treatment Outcome
D004338:Drug Combinations; D005343:Fibrinolytic Agents