Sun Young Choi1,2, Moo Hyun Kim1, Kwang Min Lee1, Young-Rak Cho1, Jong Sung Park1, Sung-Cheol Yun3, Gregory Y H Lip4,5. 1. Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea. 2. Department of Biomedical Laboratory Science, Daegu Health College, Daegu, Republic of Korea. 3. Departmentof Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. 4. Liverpool Centre for Cardiovascular Science, Liverpool Chest and Heart Hospital, University of Liverpool, Liverpool, United Kingdom. 5. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND: Although older age is one of the most important risk factors for stroke in atrial fibrillation (AF), it is unclear whether an age threshold exists for which oral anticoagulants (OACs) are beneficial for intermediate-risk AF patients. We sought to investigate the age-dependency of OAC for ischemic stroke in intermediate-risk AF patients. METHODS: We enrolled 34,701 AF patients (males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2) using the Korean National Health Insurance Service database. The clinical endpoint was the occurrence of ischemic stroke and a composite outcome (ischemic stroke + major bleeding + all-cause death). RESULTS: In AF patients aged ≥ 55 years, OAC therapy was associated with a lower risk of ischemic stroke compared with non-OAC treatment in males (55-59 years: hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.61-0.98, p = 0.038, 60-64 years: HR 0.78, 95% CI 0.61-0.96, p = 0.029, and 65-74 years: HR 0.66, 95% CI 0.49-0.84, p = 0.011) and females (55-59 years: HR 0.76, 95% CI 0.58-0.96, p = 0.027, 60-64 years: HR 0.73, 95% CI 0.55-0.93, p = 0.017, and 65-74 years: HR 0.69, 95% CI 0.51-0.87, p = 0.013). OAC was associated with a lower risk for the composite outcome compared with non-OAC for male and female patients aged ≥ 55 years. CONCLUSION: Age is an important determinant of ischemic stroke and composite outcome in intermediate-risk AF patients. The benefit of OAC therapy for these AF patients appears to have an age threshold (age ≥ 55 years). Thieme. All rights reserved.
BACKGROUND: Although older age is one of the most important risk factors for stroke in atrial fibrillation (AF), it is unclear whether an age threshold exists for which oral anticoagulants (OACs) are beneficial for intermediate-risk AF patients. We sought to investigate the age-dependency of OAC for ischemic stroke in intermediate-risk AF patients. METHODS: We enrolled 34,701 AF patients (males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2) using the Korean National Health Insurance Service database. The clinical endpoint was the occurrence of ischemic stroke and a composite outcome (ischemic stroke + major bleeding + all-cause death). RESULTS: In AF patients aged ≥ 55 years, OAC therapy was associated with a lower risk of ischemic stroke compared with non-OAC treatment in males (55-59 years: hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.61-0.98, p = 0.038, 60-64 years: HR 0.78, 95% CI 0.61-0.96, p = 0.029, and 65-74 years: HR 0.66, 95% CI 0.49-0.84, p = 0.011) and females (55-59 years: HR 0.76, 95% CI 0.58-0.96, p = 0.027, 60-64 years: HR 0.73, 95% CI 0.55-0.93, p = 0.017, and 65-74 years: HR 0.69, 95% CI 0.51-0.87, p = 0.013). OAC was associated with a lower risk for the composite outcome compared with non-OAC for male and female patients aged ≥ 55 years. CONCLUSION: Age is an important determinant of ischemic stroke and composite outcome in intermediate-risk AF patients. The benefit of OAC therapy for these AF patients appears to have an age threshold (age ≥ 55 years). Thieme. All rights reserved.
Authors: Arjun K Pandey; Ke Xu; Li Zhang; Saurabh Gupta; John Eikelboom; Renato D Lopes; Mark Crowther; Emilie P Belley-Côté; Richard P Whitlock Journal: J Thromb Thrombolysis Date: 2021-10-08 Impact factor: 2.300
Authors: Valentina Bayer; Agnieszka Kotalczyk; Bory Kea; Christine Teutsch; Peter Larsen; Dana Button; Menno V Huisman; Gregory Y H Lip; Brian Olshansky Journal: J Am Heart Assoc Date: 2022-03-04 Impact factor: 6.106