Arrhythmias & electrophysiologyCohort study
Direct oral anticoagulants in very elderly and high-bleeding-risk patients with atrial fibrillation often excluded from oral anticoagulation therapy: a nationwide population-based cohort study
- Retrospective cohort study
- nationwide population-based
- propensity score weighting
Authors' conclusion
In very elderly, high-bleeding-risk patients with AF, DOACs that were prescribed in usual clinical practice showed better effectiveness and positive net clinical benefit compared with no OAC treatment.
Study context
- Population
- Atrial fibrillation (AF) patients aged ≥80 years with ≥1 ELDERCARE-AF inclusion criterion, Korean nationwide claims database, 2014–2017
- Participants
- 23,858 patients
- Exposure
- Direct OAC (DOAC) vs no oral anticoagulant (OAC)
- DOACn = 4,893
- non-OACn = 16,575reference
- warfarinn = 2,390
- Outcome
- Ischaemic stroke, major bleeding, all-cause death and net clinical outcome
Main finding
As reported in the abstract
DOAC vs non-OACHazard ratio (95% CI)
ischaemic stroke
0.81(0.68–0.96)
all-cause death
0.91(0.86–0.96)
net clinical outcome
0.93(0.88–0.98)
Observational data: associations, not effects.
Further findings
DOAC dose use
- Low dose
- 69%
- Very low dose
- 9%
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleeding | 1.44 (1.21–1.70) | |
| 0.512Hazard ratio (log scale) |
Original publication
Direct oral anticoagulants in very elderly and high-bleeding-risk patients with atrial fibrillation often excluded from oral anticoagulation therapy: a nationwide population-based cohort study. Europace. Published 29 September 2025. doi:10.1093/europace/euaf230
Summarised from the published abstract; every number is checked against it