title: To treat or not to treat very elderly naïve patients with atrial fibrillation with vitamin K antagonists (VKA): results from the VENPAF cohort.
abstract: Despite the recommendations in the guidelines, physicians still underuse warfarin in very elderly patients with non-valvular atrial fibrillation (NVAF). The risks of stroke and major bleeding both increase with age, but it is still not clear whether the beneficial effects of vitamin K antagonists (VKA) in preventing stroke outweigh the related bleeding risks in fragile, very elderly patients. The bleeding rates reported in real-world observational studies differ considerably. The aim of this study was to retrospectively assess the incidence of major bleeding in VKA-naïve patients over 80 years old with NVAF at a large anticoagulation clinic. Significant predictors of major bleeding were also investigated. Sixty-five major bleeding events (3.4 per 100 patient-years) and 25 thromboembolic events (1.3 per 100 patient-years) were recorded in a sample of 798 patients with a median follow-up of 2.2 years. Patients over 85 years old had significantly more major bleeding events than the 80- to 84-year olds (4.7 vs. 2.6 per 100 patient-years, p 0.014). Spontaneous bleeding was also significantly more common (3.0 vs. 1.3 per 100 patient-years, p 0.008) in the very elderly group. Age and diabetes were the only independent risk factor for bleeding on multivariate Cox analysis (Age HR 1.80, 95% CI 1.10-2.93; diabetes HR 1.76, 95% CI 1.00-3.09). These data show a sharp increase in major bleeding episodes among the very elderly with atrial fibrillation. Further studies are warranted with a view to identifying patients at risk.
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy. serena.granziera@gmail.com.
authors.forename: Serena
authors.initials: S
authors.lastname: Granziera
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bertozzo
authors.affiliation: Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pengo
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Marigo
authors.affiliation: Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Gentian
authors.initials: G
authors.lastname: Denas
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: Florinda
authors.initials: F
authors.lastname: Petruzzellis
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Rossi
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Infante
authors.affiliation: Clinical Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Seena Jose
authors.initials: SJ
authors.lastname: Padayattil
authors.affiliation: Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
authors.affiliation: Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nante
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
keywords: Atrial fibrillation; Elderly; Major bleeding; Net clinical benefit; Oral anticoagulant treatment