Liu Hongyu, Chen Yang, Huang Bi, Lam Steven Ho Man, Romiti Giulio Francesco, Liu Yang, Olshansky Brian, Huisman Menno, Hong Kui, Chao Tze-Fan, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK.
Department of Genetic Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, NO.1, MINDE ROAD, Nanchang, Jiangxi 330006, China.
Age Ageing. 2025 May 31;54(6). doi: 10.1093/ageing/afaf139.
Older age increases the risk of thromboembolism (TE) and major bleeding in atrial fibrillation (AF) patients, but limited evidence exists regarding the older population (age ≥ 80) especially from different global regions. Data on benefits of oral anticoagulants in these very old individuals are also limited.
From the prospective, multicenter Global Registry on Long-Term Antithrombotic Treatment in Patients with Atrial Fibrillation registry, we analysed by age all-cause death, cardiovascular death, major adverse cardiovascular events (MACE), TE, major bleeding, stroke, and myocardial infarction (MI) over 3-years follow-up.
Of 7652 patients aged ≥75 years (age 80.1 ± 3.9 years, 47.1% male), 4006 were ≥ 80 years (age 83.4 ± 3.9 years, 43.5% male). After multivariable adjustment, older patients had a higher risk of all-cause death (HR:1.94, 95% CI: 1.67-2.27), cardiovascular death (HR: 2.17, 95% CI: 1.71-2.74), MACE (HR: 1.57, 95% CI: 1.32-1.86), TE (HR: 1.45, 95% CI: 1.14-1.83), major bleeding (HR: 1.30, 95% CI: 1.04-1.63), stroke (HR: 1.38, 95% CI: 1.06-1.80) and MI (HR: 1.59, 95% CI:1.14-2.22). Compared with VKA, NOAC use in patients ≥80 years was associated with lower risks of all-cause death (HR: 0.79, 95% CI: 0.65-0.97), cardiovascular death (HR: 0.70, 95% CI: 0.51-0.96), MACE (HR: 0.72, 95% CI: 0.56-0.92), and major bleeding (HR: 0.66, 95% CI: 0.48-0.92). NOACs were more beneficial than warfarin for mortality, MACE and major bleeding in frail patients. The risk of clinical events associated with older patients was primarily seen in Europe and Asia (p-interaction > 0.05), but the effectiveness and safety of NOACs vs. warfarin was consistent across regions.
Older age was independently associated with higher risk of death, major bleeding, TE and MACE. Compared with VKA, NOACs show improved effectiveness and safety in the older and patients with frailty, with similar efficacy across regions and ethnic groups.
高龄会增加心房颤动（AF）患者发生血栓栓塞（TE）和大出血的风险，但关于老年人群（年龄≥80岁）的证据有限，尤其是来自不同全球地区的证据。关于口服抗凝剂对这些高龄个体益处的数据也很有限。
从心房颤动患者长期抗栓治疗的前瞻性、多中心全球注册研究中，我们按年龄分析了3年随访期间的全因死亡、心血管死亡、主要不良心血管事件（MACE）、TE、大出血、中风和心肌梗死（MI）。
在7652名年龄≥75岁（年龄80.1±3.9岁，男性占47.1%）的患者中，4006名年龄≥80岁（年龄83.4±3.9岁，男性占43.5%）。经过多变量调整后，老年患者全因死亡（HR：1.94，95%CI：1.67 - 2.27）、心血管死亡（HR：2.17，95%CI：1.71 - 2.74）、MACE（HR：1.57，95%CI：1.32 - 1.86）、TE（HR：1.45，95%CI：1.14 - 1.83）、大出血（HR：1.30，95%CI：1.04 - 1.63）、中风（HR：1.38，95%CI：1.06 - 1.80）和MI（HR：1.59，95%CI：1.14 - 2.22）的风险更高。与维生素K拮抗剂（VKA）相比，≥80岁患者使用非维生素K拮抗剂口服抗凝药（NOAC）与全因死亡（HR：0.79，95%CI：0.65 - 0.97）、心血管死亡（HR：0.70，95%CI：0.51 - 0.96）、MACE（HR：0.72，95%CI：0.56 - 0.92）和大出血（HR：0.66，95%CI：0.48 - 0.92）风险较低相关。在体弱患者中，NOACs在死亡率、MACE和大出血方面比华法林更有益。与老年患者相关的临床事件风险主要在欧洲和亚洲出现（P交互作用>0.05），但NOACs与华法林相比的有效性和安全性在各地区是一致的。
高龄与更高的死亡、大出血、TE和MACE风险独立相关。与VKA相比，NOACs在老年和体弱患者中显示出更好的有效性和安全性，在各地区和种族群体中疗效相似。
