Anticoagulation Linked to Lower One-Year Mortality in Adults Aged 80+ With AF

A retrospective cohort study of 45,305 US adults aged 80 years or older with atrial fibrillation found anticoagulation use was associated with lower mortality, but more gastrointestinal bleeding. The association was strongest at one year; mortality differences converged by five years.

One-year mortality was lower among patients continuing anticoagulation.
Anticoagulation was associated with increased gastrointestinal bleeding.
Intracranial hemorrhage rates were low and similar across groups.
Mortality differences converged at five years.

Adults aged 80 years and older are underrepresented in randomized anticoagulation trials. Researchers conducted a retrospective cohort study using electronic health record data from a large US health system, including 45,305 patients with atrial fibrillation. Patients were classified as continuing, initiating, discontinuing, or never receiving anticoagulation. The primary outcome was all-cause mortality; ischemic stroke, gastrointestinal bleeding (GIB), and intracranial hemorrhage (ICH) were also assessed. Analyses included a time-varying Cox model, a 90-day landmark analysis, and propensity score matching.

At one year, mortality was 8.7% among patients who continued anticoagulation and 17.7% among those who never received it. In the time-varying model, anticoagulation was associated with a 25% lower mortality hazard (HR 0.75, 95% CI 0.71–0.79). Compared with continued anticoagulation, mortality hazards were higher among patients who initiated treatment, discontinued it, or never received it. GIB occurred in 13.0% of continuing and 11.9% of initiating patients; ICH rates were low and similar across groups (1.3–1.6%). Mortality rates converged across groups at five years.

The findings suggest age alone should not determine anticoagulation decisions, but the observational design cannot establish causation. The results may not apply to patients excluded from the study, including those with end-stage renal disease or mechanical heart valves.

In practice

For adults aged 80 years or older with atrial fibrillation, this cohort found anticoagulation use was associated with lower one-year mortality, while gastrointestinal bleeding was more frequent and intracranial hemorrhage rates were similar. The results argue against using age alone as a reason to withhold treatment, but they do not prove that anticoagulation caused the mortality difference. The retrospective design and exclusions, including patients with end-stage renal disease or mechanical heart valves, limit individual application; the findings do not replace assessment of each patient's risks and circumstances.

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Source

Journal of General Internal Medicine: Anticoagulation and All-Cause Mortality in Adults Aged 80 Years and Older with Atrial Fibrillation: A Retrospective Cohort Study ↗

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