• Something wrong with this record ?

Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation)

G. Patti, M. Lucerna, L. Pecen, JM. Siller-Matula, I. Cavallari, P. Kirchhof, R. De Caterina,

. 2017 ; 6 (7) : . [pub] 20170723

Language English Country England, Great Britain

Document type Comparative Study, Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc18024804

BACKGROUND: Increasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1-year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. METHODS AND RESULTS: We accessed individual patients' data from the prospective PREFER in AF (PREvention oF thromboembolic events-European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups. A total of 6412 patients, 505 of whom were aged ≥85 years, were analyzed. In patients aged <85 years, the incidence of thromboembolic events was 2.8%/year without OAC versus 2.3%/year with OAC (0.5% absolute reduction); in patients aged ≥85 years, it was 6.3%/year versus 4.3%/year (2% absolute reduction). In very elderly patients, the risk of major bleeding was higher than in younger patients, but similar in patients on OAC and in those on antiplatelet therapy or without antithrombotic treatment (4.0%/year versus 4.2%/year; P=0.77). OAC was overall associated with weighted net clinical benefit, assigning weights to nonfatal events according to their prognostic implication for subsequent death (-2.19%; CI, -4.23%, -0.15%; P=0.036). We found a significant gradient of this benefit as a function of age, with the oldest patients deriving the highest benefit. CONCLUSIONS: Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of OAC is highest in very elderly patients, where it, by far, outweighs the risk of bleeding, with the greatest net clinical benefit in such patients.

References provided by Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc18024804
003      
CZ-PrNML
005      
20180717084010.0
007      
ta
008      
180709s2017 enk f 000 0|eng||
009      
AR
024    7_
$a 10.1161/JAHA.117.005657 $2 doi
035    __
$a (PubMed)28736385
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a enk
100    1_
$a Patti, Giuseppe $u Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy g.patti@unicampus.it rdecater@unich.it.
245    10
$a Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation) / $c G. Patti, M. Lucerna, L. Pecen, JM. Siller-Matula, I. Cavallari, P. Kirchhof, R. De Caterina,
520    9_
$a BACKGROUND: Increasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1-year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. METHODS AND RESULTS: We accessed individual patients' data from the prospective PREFER in AF (PREvention oF thromboembolic events-European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups. A total of 6412 patients, 505 of whom were aged ≥85 years, were analyzed. In patients aged <85 years, the incidence of thromboembolic events was 2.8%/year without OAC versus 2.3%/year with OAC (0.5% absolute reduction); in patients aged ≥85 years, it was 6.3%/year versus 4.3%/year (2% absolute reduction). In very elderly patients, the risk of major bleeding was higher than in younger patients, but similar in patients on OAC and in those on antiplatelet therapy or without antithrombotic treatment (4.0%/year versus 4.2%/year; P=0.77). OAC was overall associated with weighted net clinical benefit, assigning weights to nonfatal events according to their prognostic implication for subsequent death (-2.19%; CI, -4.23%, -0.15%; P=0.036). We found a significant gradient of this benefit as a function of age, with the oldest patients deriving the highest benefit. CONCLUSIONS: Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of OAC is highest in very elderly patients, where it, by far, outweighs the risk of bleeding, with the greatest net clinical benefit in such patients.
650    _2
$a aplikace orální $7 D000284
650    _2
$a věkové faktory $7 D000367
650    _2
$a senioři $7 D000368
650    _2
$a senioři nad 80 let $7 D000369
650    _2
$a antikoagulancia $x aplikace a dávkování $x škodlivé účinky $7 D000925
650    _2
$a fibrilace síní $x komplikace $x diagnóza $x farmakoterapie $x mortalita $7 D001281
650    _2
$a klinické rozhodování $7 D000066491
650    _2
$a Evropa $7 D005060
650    _2
$a ženské pohlaví $7 D005260
650    _2
$a fibrinolytika $x aplikace a dávkování $x škodlivé účinky $7 D005343
650    _2
$a krvácení $x chemicky indukované $x mortalita $7 D006470
650    _2
$a lidé $7 D006801
650    _2
$a incidence $7 D015994
650    _2
$a tranzitorní ischemická ataka $x diagnóza $x etiologie $x mortalita $x prevence a kontrola $7 D002546
650    _2
$a mužské pohlaví $7 D008297
650    _2
$a výběr pacientů $7 D018579
650    _2
$a inhibitory agregace trombocytů $x aplikace a dávkování $x škodlivé účinky $7 D010975
650    _2
$a registrace $7 D012042
650    _2
$a hodnocení rizik $7 D018570
650    _2
$a rizikové faktory $7 D012307
650    _2
$a cévní mozková příhoda $x diagnóza $x etiologie $x mortalita $x prevence a kontrola $7 D020521
650    _2
$a tromboembolie $x diagnóza $x etiologie $x mortalita $x prevence a kontrola $7 D013923
650    _2
$a časové faktory $7 D013997
650    _2
$a výsledek terapie $7 D016896
655    _2
$a srovnávací studie $7 D003160
655    _2
$a časopisecké články $7 D016428
655    _2
$a multicentrická studie $7 D016448
700    1_
$a Lucerna, Markus $u Daiichi Sankyo Europe, Munich, Germany.
700    1_
$a Pecen, Ladislav $u Institute of Informatics, Academy of Sciences of Czech Republic, Prague, Czech Republic.
700    1_
$a Siller-Matula, Jolanta M $u Department of Cardiology, Medical University of Vienna, Austria.
700    1_
$a Cavallari, Ilaria $u Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy.
700    1_
$a Kirchhof, Paulus $u Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom. SWBH and UHB NHS Trust, Birmingham, United Kingdom.
700    1_
$a De Caterina, Raffaele $u G. d'Annunzio University of Chieti and Center of Excellence on Aging CeSI-Met, Chieti, Italy g.patti@unicampus.it rdecater@unich.it. Fondazione G. Monasterio, Pisa, Italy.
773    0_
$w MED00188127 $t Journal of the American Heart Association $x 2047-9980 $g Roč. 6, č. 7 (2017)
856    41
$u https://pubmed.ncbi.nlm.nih.gov/28736385 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y a $z 0
990    __
$a 20180709 $b ABA008
991    __
$a 20180717084309 $b ABA008
999    __
$a ok $b bmc $g 1316935 $s 1021725
BAS    __
$a 3
BAS    __
$a PreBMC
BMC    __
$a 2017 $b 6 $c 7 $e 20170723 $i 2047-9980 $m Journal of the American Heart Association $n J Am Heart Assoc $x MED00188127
LZP    __
$a Pubmed-20180709

Find record

Citation metrics

Archiving options