TY - JOUR
T1 - Antithrombotic therapy for atrial fibrillation and coronary artery disease in older patients
AU - Hess, Connie N.
AU - Broderick, Samuel
AU - Piccini, Jonathan P.
AU - Alexander, Karen P.
AU - Newby, L. Kristin
AU - Shaw, Linda K.
AU - Mahaffey, Kenneth W.
AU - Alexander, John H.
AU - Peterson, Eric D.
AU - Granger, Christopher B.
AU - Lopes, Renato D.
N1 - Funding Information:
The authors thank Peter J. Hoffman for his editorial contribution to this article. Connie N. Hess was funded by NIH grant 5T32HL069749-09 .
Funding Information:
This work was supported internally by the Duke Clinical Research Institute. Renato D. Lopes, Christopher B. Granger, Eric D. Peterson, Jonathan P. Piccini, L. Kristin Newby, Linda K. Shaw, Kenneth W. Mahaffey, and John H. Alexander have posted their conflict-of-interest information online at https://www.dcri.org/about-us/conflict-of-interest/ . Karen P. Alexander, Connie N. Hess, and Samuel Broderick have no conflicts to report.
PY - 2012/10
Y1 - 2012/10
N2 - Background: Older patients with atrial fibrillation (AF) and coronary artery disease (CAD) face high risk of stroke and bleeding with antithrombotic therapy. Balancing safe and effective use of aspirin, clopidogrel, and warfarin in this population is important. Methods: From the Duke Databank for Cardiovascular Disease, we identified patients with AF ≥65 years old with angiographically confirmed CAD from 2000 to 2010. Antithrombotic use was described across age and Congestive heart failure, Hypertension, Age >75 years, Diabetes, prior Stroke/transient ischemic attack (CHADS2) stroke risk and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding scores. Death and the composite of death, myocardial infarction, and stroke by antithrombotic strategy were reported. Results: Of 2,122 patients ≥65 years old with AF and CAD, 477 (22.5%) were ≥80 years old; 1,133 (53.4%) had acute coronary syndromes. Overall rates of aspirin, clopidogrel, and warfarin use were 83.4%, 34.6%, and 38.9%, respectively. Compared with patients 65 to 79 years old, more patients ≥80 years old were at high stroke risk (CHADS2 ≥2, 84.7% vs 57.8%) and high bleeding risk (ATRIA 5-10, 55.8% vs 23.3%). Warfarin use in both age groups increased with higher CHADS2 scores and decreased with higher ATRIA scores. Of patients ≥80 years old with CHADS2 ≥2, 150 (38.2%) received warfarin. Antithrombotic strategy was not associated with improved 1-year adjusted outcomes. Conclusions: Among older patients with AF and CAD, overall warfarin use was low. Patients ≥80 years old at highest stroke risk received warfarin in similar proportions to the overall cohort. Further investigation into optimizing antithrombotic strategies in this population is warranted.
AB - Background: Older patients with atrial fibrillation (AF) and coronary artery disease (CAD) face high risk of stroke and bleeding with antithrombotic therapy. Balancing safe and effective use of aspirin, clopidogrel, and warfarin in this population is important. Methods: From the Duke Databank for Cardiovascular Disease, we identified patients with AF ≥65 years old with angiographically confirmed CAD from 2000 to 2010. Antithrombotic use was described across age and Congestive heart failure, Hypertension, Age >75 years, Diabetes, prior Stroke/transient ischemic attack (CHADS2) stroke risk and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) bleeding scores. Death and the composite of death, myocardial infarction, and stroke by antithrombotic strategy were reported. Results: Of 2,122 patients ≥65 years old with AF and CAD, 477 (22.5%) were ≥80 years old; 1,133 (53.4%) had acute coronary syndromes. Overall rates of aspirin, clopidogrel, and warfarin use were 83.4%, 34.6%, and 38.9%, respectively. Compared with patients 65 to 79 years old, more patients ≥80 years old were at high stroke risk (CHADS2 ≥2, 84.7% vs 57.8%) and high bleeding risk (ATRIA 5-10, 55.8% vs 23.3%). Warfarin use in both age groups increased with higher CHADS2 scores and decreased with higher ATRIA scores. Of patients ≥80 years old with CHADS2 ≥2, 150 (38.2%) received warfarin. Antithrombotic strategy was not associated with improved 1-year adjusted outcomes. Conclusions: Among older patients with AF and CAD, overall warfarin use was low. Patients ≥80 years old at highest stroke risk received warfarin in similar proportions to the overall cohort. Further investigation into optimizing antithrombotic strategies in this population is warranted.
UR - http://www.scopus.com/inward/record.url?scp=84867544441&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84867544441&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2012.07.004
DO - 10.1016/j.ahj.2012.07.004
M3 - Article
C2 - 23067921
AN - SCOPUS:84867544441
SN - 0002-8703
VL - 164
SP - 607
EP - 615
JO - American heart journal
JF - American heart journal
IS - 4
ER -