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Adherence to anticoagulation therapy limited bleeding risk in older patients with AF
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Bleeding risk in patients with atrial fibrillation who are older than 80 years can be controlled with adherence to appropriate anticoagulant treatment.
Researchers for the prospective, observational study examined a cohort of 783 consecutive patients with AF who were receiving anticoagulation treatment. All patients were treated with warfarin, with the international normalized ratio maintained at the intended therapeutic range of 2 to 3.
According to the researchers, 83 patients died during the follow-up period, with nine of them having hemorrhagic complications. Patients spent a median of 14% of their time below, 71% of their time within and 15% of their time above the intended therapeutic range. Ninety-four patients experienced bleeding complications during follow-up, with 37 patients having major complications and 57 patients having minor complications.
The researchers also reported no difference in oral anticoagulation treatment quality between patients aged younger than 80 years and those aged 80 years or older. A univariate analysis suggested that an age of 80 years or older (OR=3.1; 95% CI, 1.5-6.2), a history of a previous ischemic event (OR=2.5; 95% CI, 1.3-4.8) and CHADS2 score (OR=1.3; 95% CI, 1.0-1.7) were all associated with increased risk for bleeding and that bleeding was not associated with hypertension (OR=1.3; 95% CI, 0.6-2.7) and a history of previous hemorrhage (OR=1.0; 95% CI, 0.1-6.9).
“Our study shows that in elderly patients with AF administered warfarin, the risk of bleeding is acceptably low,” the researchers concluded. “This finding suggests that patients 80 years or older could receive benefit from warfarin prophylaxis when a good quality of anticoagulation is obtained.”
Poli D. J Am Coll Cardiol. 2009;54:999-1002.