| Description |
Atrial fibrillation (AF) is the most common clinical arrhythmia, posing a major risk for occurrence of ischemic stroke. Oral anticoagulation and antiplatelet agents are used to prevent stroke. One major complication related to these therapies is the development of a hemorrhage. Providers are faced with treating older adults with AF who have concomitant geriatric syndromes that potentially alter treatment outcomes. This study involved examining records of subjects age ≥ 65 diagnosed with AF and concomitant geriatric syndromes (dementia, frailty, and/or falls) to describe differences in incidence of strokes and hemorrhages, depending upon the type of prevention therapy, and differences in incidences of stroke in patients with and without geriatric syndromes. Older adult patients with geriatric syndromes were divided into three groups based on the type of antithrombotic therapy prescribed at diagnosis of AF: oral anticoagulation, antiplatelet agents, or no oral anticoagulants or antiplatelet agents, with primary outcomes of a stroke or hemorrhage. In a separate analysis, older adults with and without geriatric syndromes across the three therapy groups were compared with primary outcome for stroke. Multivariable Cox hazard, logistic regression, and Kaplan Meier survival curves were utilized to determine association of treatment with risk-adjusted stroke and hemorrhage incidence. Compared to patients prescribed no antithrombotic therapy, the reduced stroke occurrence was 75% to 82% oral anticoagulants and 70% to 74% in those prescribed iv antiplatelet agents (both p < .001), after controlling for risk. Patients prescribed antiplatelet agents and oral anticoagulants were 3.28 and 3.19 times more likely, respectively, than patients not prescribed antithrombotics to develop noncranial hemorrhage (p < .05). Patients with geriatric syndromes experienced higher incidence of stroke when prescribed oral anticoagulants (p = 0.00) and antiplatelet agents (p < 0.001), compared to patients without geriatric syndromes. Subjects with geriatric syndromes had benefit and risk profiles when prescribed oral anticoagulant and antiplatelet therapies to prevent thromboembolism similar to other populations recorded, although overall stroke incidence was greater. This suggests that populations with geriatric syndromes should be specifically incorporated into the guidelines clinicians use to tailor antithrombotic therapies to individual patient risk. |
