Objective: We aimed to investigate the real-world prescription for anticoagulation and to compare the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin vs. no anticoagulation in anticoagulant-naïve octogenarian non-valvular atrial fibrillation (NVAF) patients. Methods: From January 1, 2013 to August 31, 2015, we identified 89 consecutive newly detected NVAF patients aged ≥80 years. We retrospectively reviewed medical records according to the differences in anticoagulation prescription (no anticoagulation, 39 patients; NOACs, 17; warfarin, 33). Results: Stroke incidence did not differ significantly among the prescriptions (no anticoagulation, 2.41; NOACs, 3.55; and warfarin, 1.28 per 100 patient-years). Considerable incidence of major bleeding was observed in the anticoagulation groups (no anticoagulation, no events; NOACs, 12.11; and warfarin, 4.30 per 100 patient-years, p = 0.570). Total bleeding tended to be high in the NOAC and warfarin groups compared to no anticoagulation (no anticoagulation, 1.21; NOACs, 20.91; warfarin, 10.76 per 100 patient-years, p = 0.054). In the multivariable Cox proportional hazard model, previous bleeding history, warfarin and NOACs treatment were significant predictors for total bleeding. Conclusion: The occurrence of total and major bleeding was excessively high in the anticoagulation groups (NOACs or warfarin) compared to the no anticoagulation group.
Real-world outcomes of anticoagulant prescription in anticoagulant-naïve octogenarian patients with non-valvular atrial fibrillation
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