Rational Pharmacotherapy in Cardiology

Advanced search

Elderly Patients with Atrial Fibrillation: Focus on Comorbidity and Safety of Anticoagulant Therapy

Full Text:


The article discusses issues related to the prescription of anticoagulant therapy to elderly patients with atrial fibrillation (AF), especially those over 70 and 80 years of age. The relevance of the issue is primarily due to the prevalence of AF in this cohort of patients, and the second is due to the higher incidence of comorbidity. The presented material demonstrates the peculiarities of anticoagulant therapy application in groups of patients older than 75, based on the data of randomized clinical trials, and also presents extrapolation of the results of RCTs to the real clinical practice (data of registers and cohort trials). The use of unreasonably low doses of oral anticoagulants in elderly patients is debated. It often leads to a decrease in the efficacy of anticoagulant therapy without improving the drugs safety profile. A new validated scale (ABH) for evaluating of anticoagulant therapy safety is presented in the article. The ABH scale can be used before prescribing to patients exactly direct oral anticoagulants. This scale is simpler and more practical than the HAS-BLED scale. The data for the ABH scale are validated based on direct oral anticoagulants in 21,248 patients from the Norwegian register. The presented results demonstrate a favorable efficiency and safety profile of rivaroxaban in comparison with warfarin in patients 75 years and older. Thus, the overall benefit for the use of rivaroxaban against warfarin in patients > 75 years of age in the subanalysis of the ROCKET-AF study was statistically significantly greater than in younger patients with AF. Data on 11121 patients with AF who were treated with rivaroxaban for the prevention of stroke and systemic embolism are included in the combined analysis of the XANTUS, XANAP and XANTUS-EL registers. 96% of patients in the study did not have serious thromboembolic events. The amount of major bleeding was 1.7 per 100 patient-years, and gastrointestinal bleeding was 0.7 per 100 patient-years. This turned out to be less than in some other registry studies. In addition, patients showed good adherence to rivaroxaban treatment: after a year, 77.4% of patients continued to take the drug.

About the Authors

D. A. Napalkov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Dmitry A. Napalkov ‒ MD, PhD, Professor, Chair of Faculty Therapy №1, Institute of Clinical Medicine

Trubetskaya ul. 8-2, Moscow, 119991 Russia

A. A. Sokolova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Anastasiya A. Sokolova – MD, PhD, Assistant, Chair of Faculty Therapy №1, Institute of Clinical Medicine

Trubetskaya ul. 8-2, Moscow, 119991 Russia


1. Krijthe B.P., Kunst A., Benjamin E.J., et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34:2746-51. DOI:10.1093/eurheartj/eht280.

2. Boriani G., Proietti M., Laroche C., et al. on behalf of the EORP-AF Long-Term General Registry Investigators. Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: a report from the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) Long-Term General Registry. Europace. 2018;20:747-57. DOI:10.1093/europace/eux301.

3. Proietti M., Laroche C., Opolski G., et al. on behalf of the AF Gen Pilot Investigators. “Real-world” atrial fibrillation management in Europe: observations from the 2-year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase. Europace. 2017;19:722-33. DOI:10.1093/europace/euw112.

4. Hess P.L., Kim S., Fonarow G.C., et al. on behalf of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Patients and Investigators. Absence of Oral Anticoagulation and Subsequent Outcomes Among Outpatients with Atrial Fibrillation. The American Journal of Medicine. 2017;130:449-56. DOI:10.1016/j.amjmed.2016.11.001.

5. Zoppellaro G., Zanella L., Denas G., Genet al. Different safety profiles of oral anticoagulants in very elderly non-valvular atrial fibrillation patients. A retrospective propensity scorematched cohort study. International Journal of Cardiology. 2018;265:103-7. DOI:10.1016/j.ijcard.2018.04.117.

6. Rutherford O.C.W., Jonasson C., Ghanima W., et al. New score for assessing bleeding risk in patients with atrial fibrillation treated with NOACs. Open Heart. 2018;5:e000931. DOI:10.1136/openhrt2018-000931.

7. Khan F., Huang H., Datta Y.H. Direct Oral Anticoagulant Use and the Incidence of Bleeding in the Very Elderly With Atrial Fibrillation. J Thromb Thrombolysis. 2016;42(4):573-8. DOI:10.1007/s11239016-1410-z.

8. Kim H.M., Choi E.K., Park C.S., et al. Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in octogenarian patients with nonvalvular atrial fibrillation. PLoS ONE. 2019;14(3):e0211766. DOI:10.1371/journal.pone.0211766.

9. Monelli M., Molteni M., Cassetti G., et al. Non-vitamin K oral anticoagulant use in the elderly: a prospective real-world study data from the REGIstry of patients on Non-vitamin Koral Anticoagulants (REGINA). Vascular Health and Risk Management. 2019;15:19-25.

10. Halperin J.L., Hankey G.J., Wojdyla D.M., et al.; ROCKET AF Steering Committee and Investigators. Efficacy and Safety of Rivaroxaban Compared With Warfarin Among Elderly Patients With Nonvalvular Atrial Fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 2014;130:138-46. DOI:10.1161/CIRCULATIONAHA.113.005008

11. Kirchhof P., Radaideh G., Kim Y.H., et al. Global XANTUS program Investigators. Global Prospective Safety Analysis of Rivaroxaban. J Am Coll Cardiol. 2018;72(2):141-53. DOI:10.1016/j.jacc.2018.04.058.

For citation:

Napalkov D.A., Sokolova A.A. Elderly Patients with Atrial Fibrillation: Focus on Comorbidity and Safety of Anticoagulant Therapy. Rational Pharmacotherapy in Cardiology. 2019;15(4):553-557. (In Russ.)

Views: 74

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)