Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea.
Department of Biomedical Laboratory Science, Daegu Health College, Daegu, Republic of Korea.
Thromb Haemost. 2021 Sep;121(9):1151-1160. doi: 10.1055/a-1336-0476. Epub 2021 Mar 9.
Although older age is one of the most important risk factors for stroke in atrial fibrillation (AF), it is unclear whether an age threshold exists for which oral anticoagulants (OACs) are beneficial for intermediate-risk AF patients. We sought to investigate the age-dependency of OAC for ischemic stroke in intermediate-risk AF patients.
We enrolled 34,701 AF patients (males with a CHADS-VASc score of 1 and females with a CHADS-VASc score of 2) using the Korean National Health Insurance Service database. The clinical endpoint was the occurrence of ischemic stroke and a composite outcome (ischemic stroke + major bleeding + all-cause death).
In AF patients aged ≥ 55 years, OAC therapy was associated with a lower risk of ischemic stroke compared with non-OAC treatment in males (55-59 years: hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.61-0.98, = 0.038, 60-64 years: HR 0.78, 95% CI 0.61-0.96, = 0.029, and 65-74 years: HR 0.66, 95% CI 0.49-0.84, = 0.011) and females (55-59 years: HR 0.76, 95% CI 0.58-0.96, = 0.027, 60-64 years: HR 0.73, 95% CI 0.55-0.93, = 0.017, and 65-74 years: HR 0.69, 95% CI 0.51-0.87, = 0.013). OAC was associated with a lower risk for the composite outcome compared with non-OAC for male and female patients aged ≥ 55 years.
Age is an important determinant of ischemic stroke and composite outcome in intermediate-risk AF patients. The benefit of OAC therapy for these AF patients appears to have an age threshold (age ≥ 55 years).
尽管年龄是心房颤动（AF）中中风的最重要危险因素之一，但尚不清楚是否存在年龄阈值，在此阈值下口服抗凝剂（OAC）对中危 AF 患者有益。我们旨在研究 OAC 对中危 AF 患者缺血性中风的年龄依赖性。
我们使用韩国国家健康保险服务数据库招募了 34701 名 AF 患者（男性 CHADS-VASc 评分为 1，女性 CHADS-VASc 评分为 2）。临床终点是缺血性中风和复合结局（缺血性中风+主要出血+全因死亡）的发生。
在年龄≥55 岁的 AF 患者中，与非 OAC 治疗相比，OAC 治疗与男性（55-59 岁：风险比 [HR]0.79，95%置信区间 [CI]0.61-0.98， = 0.038；60-64 岁：HR0.78，95%CI0.61-0.96， = 0.029；65-74 岁：HR0.66，95%CI0.49-0.84， = 0.011）和女性（55-59 岁：HR0.76，95%CI0.58-0.96， = 0.027；60-64 岁：HR0.73，95%CI0.55-0.93， = 0.017；65-74 岁：HR0.69，95%CI0.51-0.87， = 0.013）的缺血性中风风险降低。与非 OAC 相比，OAC 与年龄≥55 岁的男性和女性患者的复合结局风险降低相关。
年龄是中危 AF 患者缺血性中风和复合结局的重要决定因素。OAC 治疗对这些 AF 患者的益处似乎存在年龄阈值（年龄≥55 岁）。
