Anneka Mitchell, Margaret C Watson, Tomas J Welsh, Anita McGrogan
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Cox regression models were used to estimate adjusted HRs for stroke, bleeding, myocardial infarction, and death during periods of exposure and non-exposure and for different anticoagulants.</p><p><strong>Results: </strong>Among 20 167 patients (median age 81 years), non-exposure to anticoagulation was associated with higher risks of stroke (HR 3.07, 95% CI 2.39 to 3.93), myocardial infarction (HR 1.85, 95% CI 1.34 to 2.56) and death (HR 2.87, 95% CI 2.63 to 3.12) compared with exposure. Compared with warfarin, apixaban was associated with lower risks of non-major bleeding (HR 0.73, 95% CI 0.64 to 0.85), whereas rivaroxaban was associated with higher risks of major (HR 1.33, 95% CI 1.15 to 1.55) and non-major (HR 1.29, 95% CI 1.16 to 1.44) bleeding.</p><p><strong>Conclusions: </strong>Non-exposure to anticoagulation increases the risks of stroke, myocardial infarction and death in older patients with AF. Clinicians should carefully weigh the risks of discontinuing anticoagulation and provide shared decision-making support to patients, especially when considering deprescription.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"565-574"},"PeriodicalIF":5.1000,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods.\",\"authors\":\"Anneka Mitchell, Margaret C Watson, Tomas J Welsh, Anita McGrogan\",\"doi\":\"10.1136/heartjnl-2024-324763\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Anticoagulation therapy reduces stroke risk in patients with atrial fibrillation (AF), but it is often underused in older populations due to concerns about bleeding. 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引用次数: 0
摘要
背景:抗凝治疗可降低房颤(AF)患者的卒中风险,但由于对出血的担忧,抗凝治疗在老年人群中的应用往往不足。本研究旨在比较≥75岁房颤患者在暴露和非暴露期间以及不同抗凝药物的安全性和有效性。方法:利用2013-2017年英国临床实践研究数据链(Clinical Practice Research Datalink)的初级保健数据,对新开口服抗凝药物(华法林或直接口服抗凝药物)的患者进行回顾性队列研究。使用处方数据绘制抗凝暴露图。使用Cox回归模型来估计暴露和非暴露期间以及不同抗凝剂的卒中、出血、心肌梗死和死亡的校正hr。结果:在20167例患者(中位年龄81岁)中,与接触抗凝治疗相比,未接触抗凝治疗与较高的卒中(HR 3.07, 95% CI 2.39 - 3.93)、心肌梗死(HR 1.85, 95% CI 1.34 - 2.56)和死亡(HR 2.87, 95% CI 2.63 - 3.12)风险相关。与华法林相比,阿哌沙班与较低的非主要出血风险相关(HR 0.73, 95% CI 0.64至0.85),而利伐沙班与较高的主要出血风险相关(HR 1.33, 95% CI 1.15至1.55)和非主要出血风险相关(HR 1.29, 95% CI 1.16至1.44)。结论:未接受抗凝治疗会增加老年房颤患者卒中、心肌梗死和死亡的风险。临床医生应仔细权衡停用抗凝治疗的风险,并为患者提供共同的决策支持,尤其是在考虑停用抗凝治疗时。
Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods.
Background: Anticoagulation therapy reduces stroke risk in patients with atrial fibrillation (AF), but it is often underused in older populations due to concerns about bleeding. This study aimed to compare the safety and effectiveness of anticoagulation during periods of exposure and non-exposure and across different anticoagulants in people with AF aged ≥75 years.
Methods: Using UK primary care data from the Clinical Practice Research Datalink (2013-2017), a retrospective cohort study was conducted on patients newly prescribed oral anticoagulants (warfarin or direct oral anticoagulants). Exposure to anticoagulation was mapped using prescription data. Cox regression models were used to estimate adjusted HRs for stroke, bleeding, myocardial infarction, and death during periods of exposure and non-exposure and for different anticoagulants.
Results: Among 20 167 patients (median age 81 years), non-exposure to anticoagulation was associated with higher risks of stroke (HR 3.07, 95% CI 2.39 to 3.93), myocardial infarction (HR 1.85, 95% CI 1.34 to 2.56) and death (HR 2.87, 95% CI 2.63 to 3.12) compared with exposure. Compared with warfarin, apixaban was associated with lower risks of non-major bleeding (HR 0.73, 95% CI 0.64 to 0.85), whereas rivaroxaban was associated with higher risks of major (HR 1.33, 95% CI 1.15 to 1.55) and non-major (HR 1.29, 95% CI 1.16 to 1.44) bleeding.
Conclusions: Non-exposure to anticoagulation increases the risks of stroke, myocardial infarction and death in older patients with AF. Clinicians should carefully weigh the risks of discontinuing anticoagulation and provide shared decision-making support to patients, especially when considering deprescription.
期刊介绍:
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.