Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Population
2.2. Study Endpoints
2.3. Definition of Covariates
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Prediction of OAC Discharge Prescription
3.3. Association of OAC Type (DOACs vs. VKA) with Clinical Outcomes
3.4. Prediction of the Prescription of Full vs. Reduced DOAC Dose
3.5. Association of DOAC Dose (Full vs. Reduced) with Clinical Outcomes
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
List of Abbreviations
References
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All Patients Under OACs (n = 450, 100%) | Patients Under VKA (n = 164, 36.4%) | Patients Under DOAC (n = 286, 63.6%) | p-Value | |
---|---|---|---|---|
Demographics | ||||
Male gender, n (%) | 213 (47.3) | 77 (47) | 136 (47.6) | 0.90 |
Age, mean (SD) | 81.9 (4.3) | 81 (4.2) | 81.2 (4.3) | 0.85 |
Type of AF | ||||
Temporal type of AF, n (%) | 445 | 163 | 282 | |
First diagnosed AF, n (%) | 40 (9) | 10 (2.2) | 30 (6.7) | 0.29 |
Paroxysmal AF or atrial flutter, n (%) | 137 (30.8) | 42 (9.4) | 95 (21.3) | 0.29 |
Persistent or permanent AF, n (%) | 268 (60.2) | 111 (24.9) | 157 (35.3) | 0.29 |
Cardiovascular risk factors and comorbidities | ||||
BMI (kg/m2), mean (SD) | 28 (4.8) | 27.6 (4.9) | 28 (4.8) | 0.84 |
History of smoking (prior or current), n (%) | 234 (53.3) | 84 (52.2) | 150 (54) | 0.72 |
Serum creatinine (mg/dL), mean (SD) | 1.33 (0.88) | 1.37 (0.86) | 1.16 (0.41) | <0.01 |
CHA2DS2-VASc score, mean (SD) | 5.4 (1.4) | 5.8 (1.6) | 5.3 (1.4) | <0.01 |
HAS-BLED score, mean (SD) | 12 (0.9) | 2.43 (1.0) | 1.7 (0.8) | <0.01 |
HAS-BLED ≥ 3, n (%) | 118 (26.2) | 77 (47) | 41 (14.3) | <0.01 |
Estimated GFR with Cockcroft–Gault formula, mean (SD) | 27.5 (29.69) | 24 (27) | 28.6 (30.8) | 0.02 |
Estimated GFR with CKD-EPI formula, mean (SD) | 53.4 (19.9) | 51.9 (19.5) | 56.3 (18.3) | 0.43 |
Hemoglobin (g/dL), mean (SD) | 12.30 (2.32) | 12.3 (2.3) | 12.4 (2.5) | 0.29 |
Coronary artery disease, n (%) | 270 (60.9) | 117 (71.8) | 153 (54.6) | <0.01 |
Heart failure, n (%) | 270 (60.9) | 117 (71.8) | 153 (54.6) | <0.01 |
Prior myocardial infarction, n (%) | 270 (60.9) | 117 (71.8) | 153 (54.6) | <0.01 |
Pacemaker/ ICD, n (%) | 48 (2.5) | 25 (5.7) | 23 (5.2) | 0.07 |
Hypertension, n (%) | 389 (87.4) | 131 (80.9) | 258 (91.2) | <0.01 |
Dyslipidemia, n (%) | 218 (49.2) | 86 (52.8) | 132 (47.1) | 0.25 |
Diabetes mellitus, n (%) | 165 (37.1) | 68 (41.7) | 97 (34.4) | 0.12 |
Peripheral artery disease, n (%) | 217 (49.3) | 95 (59) | 122 (43.7) | <0.01 |
Prior ischemic stroke (%) | 57 (12.8) | 25 (15.5) | 32 (11.2) | 0.19 |
Prior systemic thromboembolic disease, n (%) | 38 (8.5) | 19 (11.8) | 19 (6.6) | 0.06 |
Prior intracranial bleeding, n (%) | 3 (0.7) | 2 (1.2) | 1 (0.4) | 0.27 |
Prior upper gastrointestinal bleeding, n (%) | 35 (7.9) | 14 (8.7) | 21 (7.4) | 0.62 |
Prior lower gastrointestinal bleeding, n (%) | 36 (8.1) | 13 (2.9) | 23 (8.1) | 0.99 |
Prior bleeding episodes, n (%) | 147 (33) | 57 (35.4) | 90 (31.7) | 0.42 |
Chronic kidney disease, n (%) | 269 (60.6) | 107 (66) | 162 (57.4) | 0.07 |
Hepatic disease, n (%) | 9 (2.1) | 3 (1.9) | 6 (2.2) | 0.83 |
Thyroid disease, n (%) | 96 (21.8) | 32 (19.9) | 64 (22.9) | 0.45 |
Medication | ||||
Use of rate control medication at discharge (b-blocker, digoxin, or both), n (%) | 362 (80.4) | 128 (78) | 234 (81.8) | 0.33 |
Use of antiplatelets at discharge (aspirin, clopidogrel, or both), n (%) | 75 (17.1) | 49 (29.9) | 26 (9.5) | <0.01 |
Use of rhythm control medication at discharge (propafenone, amiodarone, sotalol), n (%) | 79 (17.6) | 27 (16.5) | 52 (18.2) | 0.65 |
All Patients Under DOACs (N = 286, 100%) | Reduced Dose of DOACs (N = 190, 66.4%) | Full Dose of DOACs (N = 96, 33.6%) | p-Value | |
---|---|---|---|---|
Demographics | ||||
Male gender, n (%) | 134 (46.9) | 97 (51.1) | 37 (38.5) | 0.04 |
Age (years), mean (SD) | 81.2 (4.3) | 81.9 (4.4) | 79.9 (3.7) | <0.01 |
Type of AF | ||||
First diagnosed AF, n (%) | 30 (10.8) | 15 (16) | 15 (8.1) | 0.12 |
Paroxysmal AF or atrial flutter, n (%) | 94 (33.7) | 66 (35.7) | 28 (29.8) | 0.12 |
Persistent or permanent AF, n (%) | 155 (55.6) | 104 (56.2) | 51 (54.3) | 0.12 |
Cardiovascular risk factors and comorbidities | ||||
BMI (kg/m2), mean (SD) | 28.0 (4.8) | 27.6 (4.7) | 28.9 (4.8) | 0.03 |
History of smoking (prior or current), n (%) | 148 (53.8) | 106 (58.2) | 42 (45.2) | 0.04 |
Serum creatinine (mg/dL), mean (SD) | 1.16 (0.4) | 1.2 (0.4) | 1 (0.3) | <0.01 |
CHA2DS2-VASc score, mean (SD) | 5.3 (1.4) | 5.3 (1.3) | 5.2 (1.4) | 0.47 |
HAS-BLED score, mean (SD) | 1.7 (0.8) | 1.7 (0.8) | 1.7 (0.8) | 0.94 |
HAS-BLED ≥ 3, n (%) | 41 (14.5) | 29 (15.4) | 12 (12.6) | 0.53 |
Estimated GFR with Cockcroft–Gault formula, mean (SD) | 28.6 (30.8) | 29.2 (29.2) | 27.1 (34.0) | 0.59 |
Estimated GFR with CKD-EPI formula, mean (SD) | 56.3 (18.3) | 52 (17.7) | 64.5 (16.5) | <0.01 |
Hemoglobin (g/dL), mean (SD) | 12.4 (2.5) | 12.4 (2.7) | 12.4 (2.0) | 0.91 |
Coronary artery disease, n (%) | 91 (32.4) | 72 (38.7) | 19 (20.0) | <0.01 |
Heart failure, n (%) | 164 (58) | 116 (61.7) | 48 (50.5) | 0.07 |
Prior myocardial infarction, n (%) | 48 (17.3) | 41 (22.3) | 7 (7.5) | <0.01 |
Pacemaker/ ICD, n (%) | 23 (8.3) | 17 (9.2) | 6 (6.5) | 0.28 |
Hypertension, n (%) | 256 (91.4) | 169 (90.9) | 87 (92.6) | 0.63 |
Dyslipidemia, n (%) | 130 (46.9) | 84 (45.7) | 46 (49.5) | 0.55 |
Diabetes mellitus, n (%) | 97 (34.8) | 62 (33.3) | 35 (37.6) | 0.48 |
Peripheral artery disease, n (%) | 120 (43.5) | 87 (47.5) | 33 (35.5) | 0.06 |
Prior ischemic or hemorrhagic stroke or transient ischemic attack, n (%) | 47 (16.7) | 34 (18.1) | 13 (13.8) | 0.63 |
Systemic thromboembolic disease, n (%) | 19 (6.7) | 14 (7.4) | 5 (5.3) | 0.49 |
Prior intracranial bleeding, n (%) | 1 (0.4) | 1 (0.5) | 0 (0.0) | 0.47 |
Prior upper gastrointestinal bleeding, n (%) | 21 (7.5) | 13 (7.0) | 8 (8.4) | 0.67 |
Prior lower gastrointestinal bleeding, n (%) | 23 (8.2) | 15 (8.1) | 8 (8.4) | 0.92 |
Prior bleeding episodes, n (%) | 90 (32.0) | 56 (30.1) | 34 (35.8) | 0.33 |
Chronic kidney disease, n (%) | 161 (57.7) | 126 (68.1) | 35 (37.2) | <0.01 |
Hepatic disease | 6 (2.2) | 4 (2.2) | 2 (2.2) | 0.98 |
Medication | ||||
Use of rate control medication at discharge (b-blocker, digoxin, or both), n (%) | 231 (81.6) | 152 (80.9) | 79 (83.2) | 0.90 |
Use of antiplatelets at discharge (aspirin, clopidogrel, or both), n (%) | 25 (9.1) | 21 (11.4) | 4 (4.4) | 0.10 |
Use of rhythm control medication at discharge (propafenone, amiodarone, sotalol), n (%) | 52 (18.3) | 33 (20) | 19 (6.7) | 0.35 |
Univariate p-Value | Multivariate p-Value | Adjusted OR (95% CIs) | |
---|---|---|---|
Female gender | 0.90 | 0.94 | 1.02 (0.55–1.90) |
Age | 0.63 | 0.71 | 0.99 (0.94–1.05) |
Smoking (ever) | 0.72 | 0.81 | 0.94 (0.57–1.55) |
Body mass index | 0.69 | 0.62 | 0.99 (0.94–1.04) |
CHA2DS2-VASc score | <0.01 | 0.02 | 0.69 (0.50–0.95) |
HAS-BLED score | <0.01 | <0.01 | 0.33 (0.23–0.48) |
Coronary artery disease | <0.01 | 0.80 | 0.93 (0.52–1.66) |
Hypertension | <0.01 | <0.01 | 4.80 (2.30–10.00) |
Diabetes mellitus | 0.12 | 0.24 | 1.43 (0.79–2.58) |
Chronic kidney disease | 0.08 | 0.09 | 0.64 (0.39–1.07) |
Prior stroke or TIA | 0.05 | <0.01 | 4.90 (1.8–13.44) |
Prior major bleeding | 0.94 | 0.01 | 2.72 (1.26–5.88) |
Antiplatelet use | <0.01 | 0.05 | 0.74 (0.54–1.00) |
Outcome | Rates of Occurrence in VKA | Rates of Occurrence in DOACs | Log-Rank Test p-Value | Univariate HR Cis (95%) | Multivariate HR * Cis (95%) |
---|---|---|---|---|---|
All-cause mortality | 90 (54.9) | 113 (39.5) | 0.004 | 0.69 (0.50–0.88) | 0.79 (0.58–1.06) |
CV mortality | 69 (42.1) | 80 (28.0) | 0.003 | 0.62 (0.45–0.85) | 0.76 (0.53–1.07) |
Bleeding | 5 (3.4) | 16 (6.1) | 0.302 | 1.69 (0.62–4.60) | 1.50 (0.52–4.27 |
Stroke | 11 (7.5) | 11 (4.2) | 0.110 | 0.51 (0.22–1.17) | 0.43 (0.17–1.08) |
AF- or HF-related hospitalization or CV death | 116 (70.7) | 163 (57.0) | 0.297 | 0.95 (0.64–1.43) | 0.84 (0.63–1.11) |
Covariate | Univariate p-Value | Multivariate p-Value | Adjusted OR (95% CIs) |
---|---|---|---|
Diabetes mellitus | 0.477 | 0.449 | 0.74 (0.35–1.60) |
Age | <0.001 | 0.033 | 1.09 (1.01–1.17) |
Female gender | 0.044 | 0.450 | 0.73 (0.32–1.65) |
Body mass index | 0.035 | 0.969 | 1.00 (0.94–1.07) |
Smoking (ever) | 0.040 | 0.098 | 1.68 (0.91–3.12) |
Heart failure | 0.073 | 0.639 | 1.20 (0.56–2.56) |
Coronary artery disease | 0.002 | 0.730 | 1.18 (0.46–3.05) |
Prior acute myocardial infarction | 0.003 | 0.069 | 3.01 (0.92–9.88) |
Chronic kidney disease | <0.001 | <0.001 | 3.53 (1.92–6.49) |
History of any stroke or TIA | 0.366 | 0.924 | 1.07 (0.26–4.45) |
History of bleeding | 0.335 | 0.180 | 0.64 (0.33–1.23) |
HAS_BLED > 3 | 0.528 | 0.854 | 1.09 (0.42–2.82) |
CHA2DS2_VASC | 0.334 | 0.887 | 1.04 (0.64–1.67) |
Outcome | Rates of Occurrence in DOAC Reduced Dose | Rates of Occurrence in DOAC Full Dose | Log-Rank Test p-Value | Univariate HR (95% CIs) | Multivariate aHR * (95% CIs) |
---|---|---|---|---|---|
All-cause mortality | 81 (43.1) | 32 (33.7) | 0.118 | 1.32 (0.88–1.99) | 0.96 (0.60–1.53) |
CV mortality | 59 (31.4) | 21 (22.1) | 0.137 | 1.46 (0.89–2.40) | 0.84 (0.47–1.50) |
Bleeding | 11 (6.6) | 5 (5.5) | 0.659 | 1.24 (0.43–3.56) | 1.32 (0.42–4.16) |
Stroke | 7 (4.2) | 4 (4.4) | 0.993 | 0.97 (0.28–3.31) | 1.24 (0.27–5.70) |
AF- or HF-related hospitalization or CV death | 93 (49.5) | 39 (41.1) | 0.803 | 1.09 (0.75–1.59) | 0.79 (0.50–1.22) |
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Zergioti, M.; Kyriakou, M.; Papazoglou, A.S.; Kartas, A.; Moysidis, D.V.; Samaras, A.; Karagiannidis, E.; Kamperidis, V.; Ziakas, A.; Giannakoulas, G. Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation. J. Cardiovasc. Dev. Dis. 2025, 12, 86. https://doi.org/10.3390/jcdd12030086
Zergioti M, Kyriakou M, Papazoglou AS, Kartas A, Moysidis DV, Samaras A, Karagiannidis E, Kamperidis V, Ziakas A, Giannakoulas G. Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation. Journal of Cardiovascular Development and Disease. 2025; 12(3):86. https://doi.org/10.3390/jcdd12030086
Chicago/Turabian StyleZergioti, Martha, Melina Kyriakou, Andreas S. Papazoglou, Anastasios Kartas, Dimitrios V. Moysidis, Athanasios Samaras, Efstratios Karagiannidis, Vasileios Kamperidis, Antonios Ziakas, and George Giannakoulas. 2025. "Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation" Journal of Cardiovascular Development and Disease 12, no. 3: 86. https://doi.org/10.3390/jcdd12030086
APA StyleZergioti, M., Kyriakou, M., Papazoglou, A. S., Kartas, A., Moysidis, D. V., Samaras, A., Karagiannidis, E., Kamperidis, V., Ziakas, A., & Giannakoulas, G. (2025). Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation. Journal of Cardiovascular Development and Disease, 12(3), 86. https://doi.org/10.3390/jcdd12030086