Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Kardiol Pol. 2022;80(2):128-136. doi: 10.33963/KP.a2022.0046. Epub 2022 Feb 15.
Aging is an important risk factor for adverse events in elderly patients with atrial fibrillation (AF) and complicates the management of anticoagulation. Underuse of oral anticoagulants (OACs) is common in elderly patients because of comorbidities, the altered physiological function of multiple organs, frailty, risk of falls, and the lack of randomized controlled trials (RCTs) specifically for elderly patients. Nevertheless, current data still support OACs use for reducing ischemic stroke with positive net clinical benefits. Sub-analyses of RCTs and real-world cohort studies showed that non-vitamin K antagonist OACs (NOACs) would be more favorable choices compared to warfarin for stroke prevention in the elderly. This review will discuss important data on stroke prevention and the use of NOACs in elderly AF patients.
衰老是老年心房颤动（AF）患者不良事件的重要危险因素，使抗凝管理复杂化。由于合并症、多个器官生理功能改变、虚弱、跌倒风险以及缺乏专门针对老年患者的随机对照试验（RCT），老年患者口服抗凝剂（OACs）的使用率普遍较低。然而，目前的数据仍然支持 OACs 的使用，以降低缺血性中风，带来净临床获益。RCT 和真实世界队列研究的亚分析表明，与华法林相比，新型口服抗凝剂（NOACs）在老年人群中预防中风更具优势。本综述将讨论关于预防中风和老年 AF 患者使用 NOACs 的重要数据。
