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European Heart Journal Advance Access published online on December 8, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl364
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Antithrombotic therapy in elderly patients with atrial fibrillation: effects and bleeding complications: a stratified analysis of the NASPEAF randomized trial

Francisco Pérez-Gómez1,*, Jose A. Iriarte2, Javier Zumalde3, Jesus Berjón4, Antonio Salvador5,6, Eduardo Alegría7, María P. Maluenda8, Susana Asenjo9, Rosario Perez-Saldaña10, Ricardo Gómez de la Torre11, Ramón Bover12 and Cristina Fernández13

1 Section of Cardiology, Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain
2 Anticoagulation Unit, Hospital Basurto, Bilbao, Spain
3 Department of Cardiology, Hospital Galdakao, Bilbao, Spain
4 Department of Cardiology, Hospital de Navarra, Pamplona, Spain
5 Department of Cardiology, Hospital Dr. Peset, Valencia, Spain
6 Department of Cardiology, Hospital La Fe, Valencia, Spain
7 Section of Cardiology, Clínica Universitaria, Pamplona, Spain
8 Anticoagulation Unit, Hospital San Carlos, Madrid, Spain
9 Anticoagulation Unit, Hospital San Carlos, Madrid, Spain
10 Anticoagulation Unit, Centro Medico, Avenida Portugal, Madrid, Spain
11 Department of Medicine, Hospital San Agustín, Avilés, Spain
12 Instituto Cardiovascular, Hospital San Carlos, Madrid, Spain
13 Epidemiological and Research Unit, Hospital San Carlos, Madrid, Spain

Received 28 June 2006; revised 9 October 2006; accepted 19 October 2006.

* Corresponding author. Tel: +34 91 3303149; fax: +34 91 3303142. E-mail address: fperezg.hcsc{at}salud.madrid.org

Aims Atrial fibrillation patients with prior embolism have a high risk of vascular events in spite of anticoagulant therapy and elderly patients carry an additional risk. We analysed and compared vascular events-rate between older and younger than 75 years atrial fibrillation patients randomized to anticoagulant-alone or combined antiplatelet plus moderate-level anticoagulant therapy.

Methods and results A total of 967 patients stratified by age and the history of prior embolism were randomized to therapeutic doses of anticoagulant-alone or combined antithrombotic therapy. Primary events were fatal and non-fatal ischaemic or haemorrhagic stroke/transient ischaemic attack, systemic embolism and myocardial infarction, sudden death and death from bleeding. The elderly, compared with the younger patients, had higher event-rate [hazard ratio 2.31 (95% confidence interval 1.37–3.90), P<0.003]. The elderly suffered higher severe bleeding event-rate during anticoagulant therapy. The combined, compared with the anticoagulant therapy, reduced the vascular events-rate in the elderly (P=0.012) and caused less intracranial haemorrhages and less bleeding mortality, although more non-fatal gastric bleeding.

Conclusion The elderly with AF had a higher event-rate than the younger patients. A higher severe bleeding event-rate was also registered in elderly patients receiving anticoagulant therapy. Combined, compared with anticoagulant therapy, significantly reduced vascular events and bleeding mortality in elderly patients.

Key Words: Atrial fibrillation • Stroke • Haemorrhages • Elderly • Anticoagulation • Antiplatelets


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