Usage of anticoagulation therapy in patients aged 75 years or older with non-valvular paroxysmal atrial fibrillation:a real-world retrospective cohort study
Xu Ruyi
Liu Yingming
Yang Jiandu
Li Xiaoyao
Zheng Jianyong
Tian Haitao
Abstract：Objective To analyze the usage,clinical benefits and bleeding risk of oral anticoagulants(OAC)in elderly patients aged 75 years or older with non-valvular paroxysmal atrial fibrillation(PAF)based on real-world data.Methods The clinical materials were retrospectively analyzed in patients aged 75 years or older with non-valvular PAF cured in the Sixth Medical Centre of Chinese PLA General Hospital from June 2019 to Dec.2022.The risk factors were observed,OAC usage was recorded,and major end-points of death,stroke and bleeding complications were assessed through follow-up.The major observation end-points were analyzed by using Cox proportional hazard model.Results There were totally 105 patients included with average age being(84.06±6.11)years,among them there were 73 male cases(69.52%).The median follow-up time was 17.00(11.00～31.00)months.35 patients(33.33%)did not use OAC(non-OAC group)40 patients(38.10%)took dabigatran(110 mg each time,twice daily(dabigatran group),26 patients(24.76%)took rivaroxaban(rivaroxaban group)(2.5～15.0mg once daily),and 4 patients(3.81%)took warfarin(warfarin group).There were 2 cases(1.90%),1 case(0.95%)and 6 cases(5.71%)of ischemic stroke in dabigatran group and rivaroxaban group and non-OAC group,respectively.There were 2 cases(1.90%),2 cases(1.90%)and 8 cases(7.62%)of all-cause death in dabigatran group and rivaroxaban group and non-OAC group,respectively.There were 2 cases(1.90%),1 case(0.95%)and 1 case(0.95%)of severe bleeding in dabigatran group and rivaroxaban group and non-OAC group,respectively.The incidence of stoke(OR=0.108,95%CI:0.013～0.914,P=0.041)and all-cause death(OR=0.183,95%CI:0.039～0.867,P=0.032)decreased significantly in dabigatran group compared with non-OAC group,and difference had no statistical significance between rivaroxaban group and non-OAC group(P=0.108,P=0.105).The difference in severe bleeding risk had no statistical significance between non-OAC group and dabigatran group(P=0.679),and between non-OAC group and rivaroxaban group(P=0.814).Conclusion The guideline-recommended use of(OAC)is notably low among patients aged 75 years or older with non-valvular PAF.Patients who received a reduced dose of dabigatran(110 mg twice daily)showed clinical benefits,whereas those received a reduced dose of rivaroxaban(2.5～15.0 mg once daily)did not demonstrate significant benefits.
Keywords：Non-valvular paroxysmal atrial fibrillationOral anticoagulantsAcute ischemic strokeSevere bleeding
Publication Date：2025-06-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 664-670 )