Oral anticoagulation (OAC) reduces the frequency of embolic events in patients with atrial fibrillation (AF). However, this benefit is counterbalanced by an increase in bleeding. Bleeding was historically considered an acceptable price to pay for OAC therapy; however, it has recently been shown to independently impact mortality.1
Advancing age affects multiple facets of the risk-benefit assessment of anticoagulation for AF patients. Consensus guidelines categorize all patients aged 75 years and
The study cohort comprised all patients aged ≥ 75 years from the health area of Vigo (Galicia, Spain) diagnosed with AF between January 2014 and December 2017 (CardioCHUVI-AF_75 registry; ClinicalTrials.gov Identifier: NCT04364516). Electronic medical records were meticulously reviewed to confirm the diagnosis of AF and collect data on baseline clinical variables and therapeutic strategy. In all patients, the diagnosis of AF was confirmed only when it was based on an electrocardiogram. The
We studied 9365 patients aged ≥ 75 years with a confirmed diagnosis of AF. A total of 7557 patients were anticoagulated (80.7%). Of them, 6360 were anticoagulated with vitamin K antagonists (84.2%), 1070 with direct oral anticoagulants (14.1%) and 127 with heparin (1.7%). For those patients treated with vitamin K antagonists, the percentage of international normalized ratio in the therapeutic range (between 2 and 3) was 45.2%. For those patients treated with direct oral anticoagulants, 30.2% of
To our knowledge, this is the first real-world observational study to compare the prognostic impact on mortality of embolism and bleeding in a cohort of elderly AF patients. Our principal findings are as follows: a) both bleeding and embolic events are associated with an increased risk of death; b) embolic events had higher prognostic value for death than bleeding events, both for total and major episodes, although this value depended on the type of embolism and bleeding; c) the mortality rate
In elderly patients with AF, both embolic and bleeding events significantly impacted mortality within a similar time framework. Embolic events appeared to be associated with a higher risk of mortality than extracranial bleeding, except for TIAs, which have a better prognosis. For ICH, the subsequent risk of death was similar to that of major embolism. These findings may help clinicians to interpret the risk-benefit profile of anticoagulant drugs.
Daiichi Sankyo, Bayer, Boehringer Ingelheim, and Pfizer, have provided unconditional financial support for this study.
S. Raposeiras-Roubín: study design, data analysis, manuscript writing, and article submission. E. Abu-Assi: study design, data analysis and critical review of the article. M. Cespón Fernández: data collection and critical review of the article. S. Blanco Prieto: data collection and critical review of the article. C. Barreiro Pardal: data collection and critical review of the article. P. Domínguez-Erquicia: data collection and critical review of the article. M. Melendo Viu: data collection and
E. Abu-Assi is associate editor of Rev Esp Cardiol. The journal's editorial procedure to ensure impartial handling of the manuscript has been followed. Both embolic events and bleeding events are associated with a worse prognosis in patients with atrial fibrillation. The impact on mortality has been confirmed both in the short- and long-term, especially for embolic events. However, which events have more impact on the mortality: embolisms or hemorrhages? This is the first study to compareWHAT IS KNOWN ABOUT THE TOPIC?
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