Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation
Background: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral an...
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MDPI AG
2025-02-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/12/3/86 |
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| author | Martha Zergioti Melina Kyriakou Andreas S. Papazoglou Anastasios Kartas Dimitrios V. Moysidis Athanasios Samaras Efstratios Karagiannidis Vasileios Kamperidis Antonios Ziakas George Giannakoulas |
| author_facet | Martha Zergioti Melina Kyriakou Andreas S. Papazoglou Anastasios Kartas Dimitrios V. Moysidis Athanasios Samaras Efstratios Karagiannidis Vasileios Kamperidis Antonios Ziakas George Giannakoulas |
| author_sort | Martha Zergioti |
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| description | Background: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in this demographic. Methods: This post hoc analysis of the MISOAC-AF trial focused on hospitalized AF patients aged ≥ 75 years prescribed OAC at discharge. Predictors of VKA and reduced DOAC dosing were identified using adjusted odds ratios (aORs). Cox regression models calculated adjusted hazard ratios (aHRs) for primary (all-cause mortality) and secondary outcomes (stroke, bleeding, AF or heart failure hospitalization, cardiovascular death). Results: Among 450 elderly patients, 63.6% received DOACs and 36.4% received VKAs. Higher CHA2DS2-VASc and HAS-BLED scores and antiplatelet use predicted VKA prescription. Hypertension, prior stroke, and bleeding history favored DOAC use. Advanced age and chronic kidney disease correlated with reduced DOAC dosing. Over a 3.7-year follow-up period, there was no significant difference in all-cause mortality between the DOAC and VKA groups (aHR 0.79, 95% CI 0.58–1.06) or between the full-dose and reduced-dose DOAC groups (aHR 0.96, 95% CI 0.60–1.53). Secondary analyses also did not yield statistically significant results in either comparison. Conclusions: Clinical profile parameters in elderly AF patients predict VKA or DOAC use. Clinical outcomes were similar between different OAC therapies. |
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| institution | OA Journals |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-e219bf0b7f5a4dcb83315dc1cc68bfce2025-08-20T01:49:04ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-02-011238610.3390/jcdd12030086Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial FibrillationMartha Zergioti0Melina Kyriakou1Andreas S. Papazoglou2Anastasios Kartas3Dimitrios V. Moysidis4Athanasios Samaras5Efstratios Karagiannidis6Vasileios Kamperidis7Antonios Ziakas8George Giannakoulas9Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceMedical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceMedical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceMedical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece424 General Hospital of Thessaloniki, 56429 Thessaloniki, GreeceSecond Department of Cardiology, Hippokration Hospital of Thessaloniki, 54643 Thessaloniki, Greece424 General Hospital of Thessaloniki, 56429 Thessaloniki, GreeceMedical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceMedical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceMedical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceBackground: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in this demographic. Methods: This post hoc analysis of the MISOAC-AF trial focused on hospitalized AF patients aged ≥ 75 years prescribed OAC at discharge. Predictors of VKA and reduced DOAC dosing were identified using adjusted odds ratios (aORs). Cox regression models calculated adjusted hazard ratios (aHRs) for primary (all-cause mortality) and secondary outcomes (stroke, bleeding, AF or heart failure hospitalization, cardiovascular death). Results: Among 450 elderly patients, 63.6% received DOACs and 36.4% received VKAs. Higher CHA2DS2-VASc and HAS-BLED scores and antiplatelet use predicted VKA prescription. Hypertension, prior stroke, and bleeding history favored DOAC use. Advanced age and chronic kidney disease correlated with reduced DOAC dosing. Over a 3.7-year follow-up period, there was no significant difference in all-cause mortality between the DOAC and VKA groups (aHR 0.79, 95% CI 0.58–1.06) or between the full-dose and reduced-dose DOAC groups (aHR 0.96, 95% CI 0.60–1.53). Secondary analyses also did not yield statistically significant results in either comparison. Conclusions: Clinical profile parameters in elderly AF patients predict VKA or DOAC use. Clinical outcomes were similar between different OAC therapies.https://www.mdpi.com/2308-3425/12/3/86atrial fibrillationoral anticoagulationvery elderlyoctogenariansnonagenarians |
| spellingShingle | Martha Zergioti Melina Kyriakou Andreas S. Papazoglou Anastasios Kartas Dimitrios V. Moysidis Athanasios Samaras Efstratios Karagiannidis Vasileios Kamperidis Antonios Ziakas George Giannakoulas Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation Journal of Cardiovascular Development and Disease atrial fibrillation oral anticoagulation very elderly octogenarians nonagenarians |
| title | Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation |
| title_full | Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation |
| title_fullStr | Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation |
| title_full_unstemmed | Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation |
| title_short | Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation |
| title_sort | oral anticoagulation choice and dosage in very elderly patients with atrial fibrillation |
| topic | atrial fibrillation oral anticoagulation very elderly octogenarians nonagenarians |
| url | https://www.mdpi.com/2308-3425/12/3/86 |
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