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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Bleeding Risk During Oral Anticoagulation in Atrial Fibrillation Patients Older Than 80 Years

Daniela Poli, MD^_*,,_*, Emilia Antonucci, MS^_*,, Elisa Grifoni, MD^_*,, Rosanna Abbate, MD^_*,, Gian Franco Gensini, MD^_*,, and Domenico Prisco, MD^_*,

^_* Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
Centro S. Maria agli Ulivi, Fondazione Don Carlo Gnocchi Onlus IRCCS, Impruneta, Florence, Italy

Manuscript received March 13, 2009; revised manuscript received May 6, 2009, accepted May 25, 2009.

^_* Reprint requests and correspondence: Dr. Daniela Poli, Centro di Riferimento Regionale per la Trombosi, Azienda Ospedaliera Universitaria Careggi, V.le Morgagni 85-50134 Firenze, Italy (Email: polida{at}aou-careggi.toscana.it).

Objectives: We sought to evaluate the rate of bleeding in relation to age (<80 and 80 years), the quality of anticoagulation (expressed as time spent in international normalized ratio therapeutic range), and factors associated with bleeding events.

Background: Stroke prevention in patients with atrial fibrillation (AF) is an increasingly crucial public health target, particularly in patients ages 80 years.

Methods: We conducted a prospective observational study on 783 patients with AF on oral anticoagulant treatment (OAT).

Results: Patients spent a median 14%, 71%, and 15% of time below, within, and above the intended therapeutic range, respectively. No difference in OAT quality was found between patients age <80 and 80 years. During follow-up, 94 patients experienced bleeding complications (rate 3.7 x 100 patient/years), 37 major (rate 1.4 x 100 patient/years), and 57 minor (rate 2.2 x 100 patient/years). Different rates of major hemorrhage were observed between patients age <80 and 80 years (0.9 vs. 1.9 x 100 patient/years; p = 0.004). Bleeding risk also was greater in patients with a history of previous cerebral ischemic event (odds ratio [OR]: 2.5; 95% confidence interval: 1.3 to 4.8; p = 0.007). A Cox regression analysis confirmed age 80 years associated with bleeding risk (OR: 2.0).

Conclusions: These results indicate that the rate of major bleeding complications may be kept acceptably low also in very elderly AF patients on OAT, provided a careful management of anticoagulation is obtained.

Key Words: atrial fibrillation • bleeding • elderly • quality of anticoagulation • warfarin

Abbreviations and Acronyms   AF = atrial fibrillation   CHADS2 = congestive heart failure, age, diabetes, previous stroke   CI = confidence interval   INR = international normalized ratio   OAT = oral anticoagulant treatment   OR = odds ratio   TIA = transient ischemic attack

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J. Am. Coll. Cardiol. 2009 54: A26. [Full Text] [PDF]