Bleeding risk during oral anticoagulation in atrial fibrillation patients older than 80 years.
OBJECTIVE
We sought to evaluate the rate of bleeding in relation to age (<80 and > or =80 years), the quality of anticoagulation (expressed as time spent in international normalized ratio therapeutic range), and factors associated with bleeding events.


BACKGROUND
Stroke prevention in patients with atrial fibrillation (AF) is an increasingly crucial public health target, particularly in patients ages > or =80 years.


METHODS
We conducted a prospective observational study on 783 patients with AF on oral anticoagulant treatment (OAT).


RESULTS
Patients spent a median 14%, 71%, and 15% of time below, within, and above the intended therapeutic range, respectively. No difference in OAT quality was found between patients age <80 and > or =80 years. During follow-up, 94 patients experienced bleeding complications (rate 3.7 x 100 patient/years), 37 major (rate 1.4 x 100 patient/years), and 57 minor (rate 2.2 x 100 patient/years). Different rates of major hemorrhage were observed between patients age <80 and > or =80 years (0.9 vs. 1.9 x 100 patient/years; p = 0.004). Bleeding risk also was greater in patients with a history of previous cerebral ischemic event (odds ratio [OR]: 2.5; 95% confidence interval: 1.3 to 4.8; p = 0.007). A Cox regression analysis confirmed age > or =80 years associated with bleeding risk (OR: 2.0).


CONCLUSIONS
These results indicate that the rate of major bleeding complications may be kept acceptably low also in very elderly AF patients on OAT, provided a careful management of anticoagulation is obtained.
Poli
Daniela
D
Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy. polida@aou-careggi.toscana.it
Antonucci
Emilia
E
Grifoni
Elisa
E
Abbate
Rosanna
R
Gensini
Gian Franco
GF
Prisco
Domenico
D
D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin