Oral Anticoagulation in Atrial Fibrillation. Comparison Between Patients Younger and Older Than 75 Years

Abstract Atrial fibrillation (AF) is the most common cardiac rhythm disorder. The prevalence is nearly 10 % in patients (pts) older than 75 years (yrs). Some authors are reluctant to give oral anticoagulant therapy for older pts based on their higher incidence of bleeding Objective: to compare characteristics, incidence of thrombosis and bleeding in 2 groups of pts with AF, under OA for at least 3 months. Methods: we retrospectively analyzed 184 pts below 75 yrs (Group A) and 133 pts with 75 yrs and older (Group B), between Jan 2002 and Aug 2007. Results: the mean follow-up was 514 pts/year for the A group and 382 pts/year for group B. The features of each group are listed in the table below: Group A Group B p Age (mean- range) 64,9 (33/74) 79,8 (75/91) Gender (M/F) 116/68 (1,7/1) 55/78 (0,7/1) Rheumatic AF 89/184 61/114 Non valvular AF 80/184 53/114 Previous thrombosis 21/184 (11.4%) 29/133 (21.8%) 0,01 Diabetes mellitus 28/184 (15.2%) 10/133 (7.5%) 0,05 Arterial Hypertension 78/184 (42.3 %) 53/133 (39.8%) Hyperthyroidism 29/184 (15.7%) 18/133 (13.5%) Left Mega Atrium 43/174 (24.7%) 32/110 (29%) Coronary Artery Disease 38/184 (20.6%) 31/133 (23.3%) Cardiomegaly 53/170 (31.1%) 41/122 (33.6%) Ejection Fraction ≤30% 26/175 (14,8%) 20/112 (17.8%) Creatinin ≥ 2 mg/dl 8/184 (4.3%) 8/133 (6.1%) Thromboses 4/184 (2.1%) 3/133 (2.2%) Bleeding minor 59/184 (32%} 49/133 (36.8%) major 5/184 (2.7%) 2/133 (1.5%) fatal 0 2/2 (100%) Controls with INR 2-3 61 % 60,5 % Conclusion: There was no difference in the incidence of major and minor bleeding/thrombotic complications between the groups. Group B disclosed a higher number of thromboses previous to OA therapy, and fewer pts with diabetes. In our experience, OA seemed to be equally safe and effective when we compared both populations. There was no difference in the incidence of major and minor bleeding/thrombotic complications between the groups.