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Thromb Haemost 2021; 121(09): 1151-1160
DOI: 10.1055/a-1336-0476
Coagulation and Fibrinolysis

Age-Dependent Anticoagulant Therapy for Atrial Fibrillation Patients with Intermediate Risk of Ischemic Stroke: A Nationwide Population-Based Study

Sun Young Choi
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
,
Moo Hyun Kim 
1   Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
,
Kwang Min Lee
1   Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
,
Young-Rak Cho
1   Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
,
Jong Sung Park
1   Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
,
Sung-Cheol Yun
3   Departmentof Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Gregory Y. H. Lip    *
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
› Author Affiliations Funding This research was supported by a grant from the Ministry of Education, Science and Technology (NRF- 2018R1D1A1A09083902) to M.H.K., as well as support from the Ministry of Education (NRF-2017R1D1A3B03035713) to S.Y.C.
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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).

Keywords

atrial fibrillation - anticoagulant - stroke - intracranial hemorrhage - age

* The editorial process for this paper was fully handled by Prof Christian Weber, Editor-in-Chief.




Publication History

Received: 07 September 2020

Accepted: 08 December 2020

Accepted Manuscript online:
11 December 2020

Article published online:
09 March 2021

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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