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. 2025 Feb 26;12(3):86.
doi: 10.3390/jcdd12030086.

Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation

Martha Zergioti  1 , Melina Kyriakou  1 , Andreas S Papazoglou  1 , Anastasios Kartas  1 , Dimitrios V Moysidis  2 , Athanasios Samaras  3 , Efstratios Karagiannidis  2 , Vasileios Kamperidis  1   4 , Antonios Ziakas  1   4 , George Giannakoulas  1   4
Affiliations

Oral Anticoagulation Choice and Dosage in Very Elderly Patients with Atrial Fibrillation

Martha Zergioti et al. J Cardiovasc Dev Dis. .

Abstract

Background: Selecting the optimal oral anticoagulation (OAC) therapy for elderly patients with atrial fibrillation (AF) remains challenging. Our real-world study investigates clinical factors guiding OAC prescription patterns and compares outcomes between full- and reduced-dose direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in this demographic.

Methods: This post hoc analysis of the MISOAC-AF trial focused on hospitalized AF patients aged ≥ 75 years prescribed OAC at discharge. Predictors of VKA and reduced DOAC dosing were identified using adjusted odds ratios (aORs). Cox regression models calculated adjusted hazard ratios (aHRs) for primary (all-cause mortality) and secondary outcomes (stroke, bleeding, AF or heart failure hospitalization, cardiovascular death).

Results: Among 450 elderly patients, 63.6% received DOACs and 36.4% received VKAs. Higher CHA2DS2-VASc and HAS-BLED scores and antiplatelet use predicted VKA prescription. Hypertension, prior stroke, and bleeding history favored DOAC use. Advanced age and chronic kidney disease correlated with reduced DOAC dosing. Over a 3.7-year follow-up period, there was no significant difference in all-cause mortality between the DOAC and VKA groups (aHR 0.79, 95% CI 0.58-1.06) or between the full-dose and reduced-dose DOAC groups (aHR 0.96, 95% CI 0.60-1.53). Secondary analyses also did not yield statistically significant results in either comparison.

Conclusions: Clinical profile parameters in elderly AF patients predict VKA or DOAC use. Clinical outcomes were similar between different OAC therapies.

Keywords: atrial fibrillation; nonagenarians; octogenarians; oral anticoagulation; very elderly.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves plotted to illustrate the association of VKAs or DOACs with the occurrence of any: (A) all-cause mortality, (B) stroke, (C) major bleeding episode, (D) AF- or HF-related hospitalization or cardiovascular death.
Figure 2
Figure 2
Kaplan–Meier curves plotted to illustrate the association of full or reduced DOAC dose with the occurrence of any: (A) all-cause mortality, (B) stroke, (C) major bleeding episode, (D) AF- or HF-related hospitalization or cardiovascular death.
See this image and copyright information in PMC

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