Peter Appelros1, Bahman Farahmand2, Andreas Terént2, Signild Åsberg2. 1. From the Department of Neurology, Örebro University Hospital, Sweden (P.A.); Epi-consultant Formerly Karolinska Institute, Alzheimer Disease Research Center, Gävlegatan, Stockholm, Sweden (B.F.); and Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset, Sweden (A.T., S.A.). peter.appelros@regionorebrolan.se. 2. From the Department of Neurology, Örebro University Hospital, Sweden (P.A.); Epi-consultant Formerly Karolinska Institute, Alzheimer Disease Research Center, Gävlegatan, Stockholm, Sweden (B.F.); and Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset, Sweden (A.T., S.A.).
Abstract
BACKGROUND AND PURPOSE: Anticoagulant treatment is effective for preventing recurrent ischemic strokes in patients who have atrial fibrillation. This benefit is paid by a small increase of hemorrhages. Anticoagulant-related hemorrhages seem to increase with age, but there are few studies showing whether the benefits of treatment persist in old age. METHODS: For this observational study, 4 different registers were used, among them Riksstroke, the Swedish Stroke Register. Patients who have had a recent ischemic stroke, were 80 to 100 years of age, and had atrial fibrillation, were included from 2006 through 2013. The patients were stratified into 3 age groups: 80 to 84, 85 to 89, and ≥90 years of age. Information on stroke severity, risk factors, drugs, and comorbidities was gathered from the registers. The patients were followed with respect to ischemic or hemorrhagic stroke, other hemorrhages, or death. RESULTS: Of all 23 356 patients with atrial fibrillation, 6361 (27%) used anticoagulants after an ischemic stroke. Anticoagulant treatment was associated with less recurrent ischemic stroke in all age groups. Hemorrhages increased most in the ≥90-year age group, but this did not offset the overall beneficial effect of the anticoagulant. Apart from age, no other cardiovascular risk factor or comorbidity was identified that influenced the risk of anticoagulant-associated hemorrhage. Drugs other than anticoagulants did not influence the incidence of major hemorrhage. CONCLUSIONS: Given the patient characteristics in this study, there is room for more patients to be treated with anticoagulants, without hemorrhages to prevail. In nonagenarians, hemorrhages increased somewhat more, but this did not affect the overall outcome in this age stratum.
BACKGROUND AND PURPOSE: Anticoagulant treatment is effective for preventing recurrent ischemic strokes in patients who have atrial fibrillation. This benefit is paid by a small increase of hemorrhages. Anticoagulant-related hemorrhages seem to increase with age, but there are few studies showing whether the benefits of treatment persist in old age. METHODS: For this observational study, 4 different registers were used, among them Riksstroke, the Swedish Stroke Register. Patients who have had a recent ischemic stroke, were 80 to 100 years of age, and had atrial fibrillation, were included from 2006 through 2013. The patients were stratified into 3 age groups: 80 to 84, 85 to 89, and ≥90 years of age. Information on stroke severity, risk factors, drugs, and comorbidities was gathered from the registers. The patients were followed with respect to ischemic or hemorrhagic stroke, other hemorrhages, or death. RESULTS: Of all 23 356 patients with atrial fibrillation, 6361 (27%) used anticoagulants after an ischemic stroke. Anticoagulant treatment was associated with less recurrent ischemic stroke in all age groups. Hemorrhages increased most in the ≥90-year age group, but this did not offset the overall beneficial effect of the anticoagulant. Apart from age, no other cardiovascular risk factor or comorbidity was identified that influenced the risk of anticoagulant-associated hemorrhage. Drugs other than anticoagulants did not influence the incidence of major hemorrhage. CONCLUSIONS: Given the patient characteristics in this study, there is room for more patients to be treated with anticoagulants, without hemorrhages to prevail. In nonagenarians, hemorrhages increased somewhat more, but this did not affect the overall outcome in this age stratum.
Authors: Matthew Alcusky; David D McManus; Anne L Hume; Marc Fisher; Jennifer Tjia; Kate L Lapane Journal: J Am Heart Assoc Date: 2019-05-07 Impact factor: 5.501
Authors: Anna Gundlund; Ying Xian; Eric D Peterson; Jawad H Butt; Kasper Gadsbøll; Jonas Bjerring Olesen; Lars Køber; Christian Torp-Pedersen; Gunnar H Gislason; Emil Loldrup Fosbøl Journal: JAMA Netw Open Date: 2018-05-18