PDF(Pubmed)
Abstract：
UNASSIGNED: The All Nippon Atrial Fibrillation In the Elderly Registry provides real-world insights into non-valvular atrial fibrillation (NVAF) in >30,000 elderly Japanese patients (aged ≥75 years), including >2,000 nonagenarians. We aimed to investigate outcomes in these patients by age and oral anticoagulant (OAC) type.
UNASSIGNED: This prospective, multicenter, observational, cohort, 2-year follow-up study included elderly patients with NVAF who were able to attend hospital visits. The incidences of stroke/systemic embolic events (SEE), major bleeding, intracranial hemorrhage (ICH), cardiovascular death, all-cause death, and major adverse cardiovascular or neurological events (MACNE) were evaluated by age. Incidence rates increased significantly with age. Stroke/SEE, major bleeding, and ICH incidences plateaued in patients aged ≥90 years. Direct OACs (DOACs) yielded a numerically lower event incidence vs. warfarin in all age groups and endpoints, except for major bleeding in patients aged ≥90 years. DOACs (vs. warfarin) were significantly associated with a lower risk of stroke/SEE, major bleeding, and ICH in the ≥80-<85 years group, and reduced cardiovascular and all-cause death in the ≥75-<80 years group. In the ≥90 years subgroup, major bleeding history was a risk factor for all-cause death.
UNASSIGNED: Although DOAC vs. warfarin offers potential benefits for stroke prevention, limitations occurred in reducing major bleeding among those aged ≥90 years, indicating a potential benefit of very-low-dose DOAC for this demographic.
UNASSIGNED: This prospective, multicenter, observational, cohort, 2-year follow-up study included elderly patients with NVAF who were able to attend hospital visits. The incidences of stroke/systemic embolic events (SEE), major bleeding, intracranial hemorrhage (ICH), cardiovascular death, all-cause death, and major adverse cardiovascular or neurological events (MACNE) were evaluated by age. Incidence rates increased significantly with age. Stroke/SEE, major bleeding, and ICH incidences plateaued in patients aged ≥90 years. Direct OACs (DOACs) yielded a numerically lower event incidence vs. warfarin in all age groups and endpoints, except for major bleeding in patients aged ≥90 years. DOACs (vs. warfarin) were significantly associated with a lower risk of stroke/SEE, major bleeding, and ICH in the ≥80-<85 years group, and reduced cardiovascular and all-cause death in the ≥75-<80 years group. In the ≥90 years subgroup, major bleeding history was a risk factor for all-cause death.
UNASSIGNED: Although DOAC vs. warfarin offers potential benefits for stroke prevention, limitations occurred in reducing major bleeding among those aged ≥90 years, indicating a potential benefit of very-low-dose DOAC for this demographic.
摘要：
■《日本老年心房颤动登记处》为30,000名日本老年患者（年龄≥75岁）的非瓣膜性心房颤动（NVAF）提供了真实见解，包括>2,000名年轻人。我们旨在按年龄和口服抗凝剂（OAC）类型调查这些患者的预后。
■这个前景，多中心，观察,队列,为期2年的随访研究包括能够参加医院访问的患有NVAF的老年患者。卒中/全身栓塞事件（SEE）的发生率，大出血,颅内出血（ICH），心血管死亡,全因死亡,按年龄评估主要不良心血管或神经系统事件(MACNE).发病率随着年龄的增长而显著增加。Stroke/SEE,大出血,年龄≥90岁患者的ICH发病率趋于稳定。直接OAC（DOAC）产生的事件发生率与华法林在所有年龄组和终点，除了90岁以上患者的大出血。DOAC(vs.华法林）与较低的卒中/SEE风险显着相关，大出血,≥80-<85岁组的ICH，≥75-<80岁组的心血管疾病和全因死亡减少。在≥90岁亚组中，大出血史是全因死亡的危险因素.
■虽然DOAC与华法林为预防中风提供了潜在的益处，在年龄≥90岁的人群中，在减少大出血方面存在局限性，表明极低剂量DOAC对该人群有潜在益处。
■这个前景，多中心，观察,队列,为期2年的随访研究包括能够参加医院访问的患有NVAF的老年患者。卒中/全身栓塞事件（SEE）的发生率，大出血,颅内出血（ICH），心血管死亡,全因死亡,按年龄评估主要不良心血管或神经系统事件(MACNE).发病率随着年龄的增长而显著增加。Stroke/SEE,大出血,年龄≥90岁患者的ICH发病率趋于稳定。直接OAC（DOAC）产生的事件发生率与华法林在所有年龄组和终点，除了90岁以上患者的大出血。DOAC(vs.华法林）与较低的卒中/SEE风险显着相关，大出血,≥80-<85岁组的ICH，≥75-<80岁组的心血管疾病和全因死亡减少。在≥90岁亚组中，大出血史是全因死亡的危险因素.
■虽然DOAC与华法林为预防中风提供了潜在的益处，在年龄≥90岁的人群中，在减少大出血方面存在局限性，表明极低剂量DOAC对该人群有潜在益处。
