THE CURRENT STATE OF ANTICOAGULANT USAGE AND ASSOCIATED COMPLICATIONS IN ELDERLY PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

Abstract

Background: Non-valvular atrial fibrillation (NVAF) is a common condition in the elderly, with incidence increasing with age. Anticoagulation therapy plays a key role in significantly reducing the risk of thromboembolic events in these patients. However, individuals aged 75 years and older often present with multiple comorbidities, requiring a more cautious approach in the management of anticoagulant uses. Therefore, investigating the current status and complications associated with anticoagulant use in this age group can provide a foundation for more effective anticoagulant prescription.Objective: To investigate the complications and contributing factors related to anticoagulant management.

Methods: This cohort study was conducted by reviewing electronic health records and conducting telephone interviews with patients aged 75 years or older who were diagnosed with non-valvular atrial fibrillation and attended the Heart Institute between January 1, 2022, and July 31, 2023. The study concluded on July 31, 2024. Patients on concomitant antiplatelet therapy or with stage 4 or 5 chronic kidney disease were excluded.

Results: A total of 98 patients were included in the analysis. The dropout rate for follow-up visits was higher in male patients compared to female patients with statistical significance (p <0.001). In the group using NOACs, 45% were on suboptimal doses, lower than the recommended doses. In the group using vitamin K antagonists, only 22% maintained an INR within the therapeutic range. There was no significant difference in the incidence of severe complications between the NOAC group and the VKA group (4.8% vs. 4.2%, p = 0.83).

Conclusion: Most patients in the study were prescribed anticoagulants. However, the INR was often below the therapeutic range, and a high proportion of NOAC doses were lower than the recommended doses. The dropout rate was high, especially among men.

Keywords: anticoagulants; NOAC; antivitamin K; atrial fibrillation; elderly