Arrhythmias & electrophysiology
Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods
Authors' conclusion
Non-exposure to anticoagulation increases the risks of stroke, myocardial infarction and death in older patients with AF. Clinicians should carefully weigh the risks of discontinuing anticoagulation and provide shared decision-making support to patients, especially when considering deprescription.
Study context
- Population
- Patients with atrial fibrillation (AF) aged ≥75 years newly prescribed oral anticoagulants (warfarin or direct oral anticoagulants), UK primary care data from the Clinical Practice Research Datalink (2013–2017)median age 81 years
- Participants
- 20,167 patients
- Exposure
- Periods of exposure and non-exposure and different anticoagulants
- Outcome
- Stroke, myocardial infarction and death
Main finding
As reported in the abstract
non-exposure vs exposureHazard ratio (95% CI)
Stroke
3.07(2.39–3.93)
Myocardial infarction
1.85(1.34–2.56)
Death
2.87(2.63–3.12)
Observational data: associations, not effects.
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| BleedingApixaban vs warfarin · non-major bleeding · adjusted HRs | 0.73 (0.64–0.85) | |
| BleedingRivaroxaban vs warfarin · major bleeding · adjusted HRs | 1.33 (1.15–1.55) | |
| BleedingRivaroxaban vs warfarin · non-major bleeding · adjusted HRs | 1.29 (1.16–1.44) | |
| 0.512Hazard ratio (log scale) |
Original publication
Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods. Heart. Published 17 February 2025. doi:10.
Summarised from the published abstract; every number is checked against it