Okoye Chukwuma, Finazzi Alberto, Pagan Eleonora, Brunetti Enrico, Presta Roberto, Monzani Fabio, Bellelli Giuseppe, Bo Mario
School of Medicine and Surgery, University of Milano-Bicocca, Milan, via Pergolesi, 33, 20900, Monza, MB, Italy.
Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, Lombardia, Italy.
Drugs Aging. 2025 Jul 9. doi: 10.1007/s40266-025-01229-x.
Atrial fibrillation (AF) is common in older adults, and anticoagulation is recommended for those aged 75 years and older. Still, many individuals remain untreated due to concerns about the benefit-risk balance, particularly among the frail. This study examines the association of incident ischemic stroke (IS) and major or clinically relevant nonmajor bleeding (MB/CRNMB) on 1-year mortality in older patients receiving oral anticoagulants (OAC).
This retrospective multicenter study included individuals aged ≥ 75 years with AF, discharged between 2014 and 2018 from three acute geriatric units. Baseline functional and frailty status were collected. OAC use at discharge was identified through review of clinical charts. Data on 1-year survival, IS, and MB/CRNMB were extracted from a centralized database. Associations with 1-year mortality were analyzed using a multivariable Cox model with IS and MB/CRNMB as time-dependent variables.
The study included 1684 patients with AF, median age 86 years (interquartile range 82-90), of whom 59.8% were female. Most patients were frail (67.2%) or prefrail (24.2%). Within 1 year, 609 (36.2%) patients died; there were 50 (2.9%) cases of IS and 79 (4.7%) cases of MB/CRNMB. Multivariable Cox analysis showed that incident MB/CRNMB (hazard ratio, HR: 3.82, 95% confidence intervals, CI 2.68-5.45) and IS (HR: 1.82, 95% CI 1.14-2.90) were independently associated with increased 1-year mortality.
In total, one third of older adults with AF receiving OAC die within a year of discharge. Incident MB/CRNMB was more strongly associated with reduced survival than incident IS, underscoring the clinical complexity of anticoagulation management in this high-risk population.
心房颤动（AF）在老年人中很常见，建议75岁及以上的患者进行抗凝治疗。然而，由于对获益风险平衡的担忧，许多人仍未接受治疗，尤其是在体弱人群中。本研究探讨了接受口服抗凝剂（OAC）治疗的老年患者发生缺血性卒中（IS）和大出血或临床相关非大出血（MB/CRNMB）与1年死亡率之间的关联。
这项回顾性多中心研究纳入了年龄≥75岁的AF患者，这些患者于2014年至2018年间从三个急性老年病科出院。收集了基线功能和虚弱状态。通过查阅临床病历确定出院时使用OAC的情况。从一个集中数据库中提取了1年生存率、IS和MB/CRNMB的数据。使用多变量Cox模型分析与1年死亡率的关联，将IS和MB/CRNMB作为时间依赖性变量。
该研究纳入了1684例AF患者，中位年龄86岁（四分位间距82 - 90岁），其中59.8%为女性。大多数患者体弱（67.2%）或处于虚弱前期（24.2%）。在1年内，609例（36.2%）患者死亡；有50例（2.9%）发生IS，79例（4.7%）发生MB/CRNMB。多变量Cox分析显示，发生MB/CRNMB（风险比，HR：3.82，95%置信区间，CI 2.68 - 5.45）和IS（HR：1.82，95% CI 1.14 - 2.90）与1年死亡率增加独立相关。
总体而言，接受OAC治疗的老年AF患者中有三分之一在出院后一年内死亡。发生MB/CRNMB比发生IS与生存率降低的关联更强，这突出了该高危人群抗凝管理的临床复杂性。
