BACKGROUND: Older patients with atrial fibrillation (AF) and coronary artery disease (CAD) face high risk of stroke and bleeding with antithrombotic therapy. Balancing safe and effective use of aspirin, clopidogrel, and warfarin in this population is important. METHODS: From the Duke Databank for Cardiovascular Disease, we identified patients with AF ≥65 years old with angiographically confirmed CAD from 2000 to 2010. Antithrombotic use was described across age and Congestive heart failure, Hypertension, Age >75 years, Diabetes, prior Stroke/transient ischemic attack (CHADS(2)) stroke risk and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding scores. Death and the composite of death, myocardial infarction, and stroke by antithrombotic strategy were reported. RESULTS: Of 2,122 patients ≥65 years old with AF and CAD, 477 (22.5%) were ≥80 years old; 1,133 (53.4%) had acute coronary syndromes. Overall rates of aspirin, clopidogrel, and warfarin use were 83.4%, 34.6%, and 38.9%, respectively. Compared with patients 65 to 79 years old, more patients ≥80 years old were at high stroke risk (CHADS(2) ≥2, 84.7% vs 57.8%) and high bleeding risk (ATRIA 5-10, 55.8% vs 23.3%). Warfarin use in both age groups increased with higher CHADS(2) scores and decreased with higher ATRIA scores. Of patients ≥80 years old with CHADS(2) ≥2, 150 (38.2%) received warfarin. Antithrombotic strategy was not associated with improved 1-year adjusted outcomes. CONCLUSIONS: Among older patients with AF and CAD, overall warfarin use was low. Patients ≥80 years old at highest stroke risk received warfarin in similar proportions to the overall cohort. Further investigation into optimizing antithrombotic strategies in this population is warranted.
BACKGROUND: Older patients with atrial fibrillation (AF) and coronary artery disease (CAD) face high risk of stroke and bleeding with antithrombotic therapy. Balancing safe and effective use of aspirin, clopidogrel, and warfarin in this population is important. METHODS: From the Duke Databank for Cardiovascular Disease, we identified patients with AF ≥65 years old with angiographically confirmed CAD from 2000 to 2010. Antithrombotic use was described across age and Congestive heart failure, Hypertension, Age >75 years, Diabetes, prior Stroke/transient ischemic attack (CHADS(2)) stroke risk and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding scores. Death and the composite of death, myocardial infarction, and stroke by antithrombotic strategy were reported. RESULTS: Of 2,122 patients ≥65 years old with AF and CAD, 477 (22.5%) were ≥80 years old; 1,133 (53.4%) had acute coronary syndromes. Overall rates of aspirin, clopidogrel, and warfarin use were 83.4%, 34.6%, and 38.9%, respectively. Compared with patients 65 to 79 years old, more patients ≥80 years old were at high stroke risk (CHADS(2) ≥2, 84.7% vs 57.8%) and high bleeding risk (ATRIA 5-10, 55.8% vs 23.3%). Warfarin use in both age groups increased with higher CHADS(2) scores and decreased with higher ATRIA scores. Of patients ≥80 years old with CHADS(2) ≥2, 150 (38.2%) received warfarin. Antithrombotic strategy was not associated with improved 1-year adjusted outcomes. CONCLUSIONS: Among older patients with AF and CAD, overall warfarin use was low. Patients ≥80 years old at highest stroke risk received warfarin in similar proportions to the overall cohort. Further investigation into optimizing antithrombotic strategies in this population is warranted.
Authors: Valentin Fuster; Lars E Rydén; David S Cannom; Harry J Crijns; Anne B Curtis; Kenneth A Ellenbogen; Jonathan L Halperin; Jean-Yves Le Heuzey; G Neal Kay; James E Lowe; S Bertil Olsson; Eric N Prystowsky; Juan Luis Tamargo; Samuel Wann; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffery L Anderson; Elliott M Antman; Jonathan L Halperin; Sharon Ann Hunt; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Silvia G Priori; Jean-Jacques Blanc; Andrzej Budaj; A John Camm; Veronica Dean; Jaap W Deckers; Catherine Despres; Kenneth Dickstein; John Lekakis; Keith McGregor; Marco Metra; Joao Morais; Ady Osterspey; Juan Luis Tamargo; José Luis Zamorano Journal: Circulation Date: 2006-08-15 Impact factor: 29.690
Authors: S Connolly; J Pogue; R Hart; M Pfeffer; S Hohnloser; S Chrolavicius; M Pfeffer; S Hohnloser; S Yusuf Journal: Lancet Date: 2006-06-10 Impact factor: 79.321
Authors: Michael B Rothberg; Carmel Celestin; Louis D Fiore; Elizabeth Lawler; James R Cook Journal: Ann Intern Med Date: 2005-08-16 Impact factor: 25.391
Authors: M B Leon; D S Baim; J J Popma; P C Gordon; D E Cutlip; K K Ho; A Giambartolomei; D J Diver; D M Lasorda; D O Williams; S J Pocock; R E Kuntz Journal: N Engl J Med Date: 1998-12-03 Impact factor: 91.245
Authors: Alanna M Chamberlain; Bernard J Gersh; Roger M Mills; Winslow Klaskala; Alvaro Alonso; Susan A Weston; Véronique L Roger Journal: Am J Cardiol Date: 2015-01-31 Impact factor: 2.778
Authors: Benjamin A Steinberg; Samuel H Broderick; Renato D Lopes; Linda K Shaw; Kevin L Thomas; Tracy A DeWald; James P Daubert; Eric D Peterson; Christopher B Granger; Jonathan P Piccini Journal: Europace Date: 2014-04-21 Impact factor: 5.214
Authors: Hanna K Al-Makhamreh; Mohammed Q Al-Sabbagh; Ala' E Shaban; Abdelrahman F Obiedat; Ayman J Hammoudeh Journal: Medicina (Kaunas) Date: 2021-06-11 Impact factor: 2.430