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Review

Managing older people with atrial fibrillation and preventing stroke: a review of anticoagulation approaches

ORCID Icon, ORCID Icon, , ORCID Icon & ORCID Icon
Pages 963-983 | Received 14 Sep 2023, Accepted 25 Oct 2023, Published online: 13 Dec 2023

References

  • Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22(8):983–988. doi: 10.1161/01.STR.22.8.983
  • Di Carlo A, Bellino L, Consoli D, et al. Prevalence of atrial fibrillation in the Italian elderly population and projections from 2020 to 2060 for Italy and the European Union: the FAI project. EP Europace. 2019;21(10):1468–1475. doi: 10.1093/europace/euz141
  • Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart study. JAMA. 1994;271(11):840–844. doi: 10.1001/jama.1994.03510350050036
  • Heeringa J, van der Kuip DAM, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27(8):949–953. doi: 10.1093/eurheartj/ehi825
  • Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (the cardiovascular health study). Am J Cardiol. 1994;74(3):236–241. doi: 10.1016/0002-9149(94)90363-8
  • Marinigh R, Lip GY, Fiotti N, et al. Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol. 2010;56(11):827–837. doi: 10.1016/j.jacc.2010.05.028
  • Vanbeselaere V, Truyers C, Elli S, et al. Association between atrial fibrillation, anticoagulation, risk of cerebrovascular events and multimorbidity in general practice: a registry-based study. BMC Cardiovasc Disord. 2016;16(1):61. doi: 10.1186/s12872-016-0235-1
  • Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–439. doi: 10.1016/j.arr.2011.03.003
  • Dalgaard F, Xu H, Matsouaka RA, et al. Management of atrial fibrillation in older patients by morbidity burden: insights from get with the guidelines‐atrial fibrillation. J Am Heart Assoc. 2020;9(23):e017024. doi: 10.1161/JAHA.120.017024
  • Lip GYH. Managing high-risk atrial fibrillation patients with multiple comorbidities. Int J Arrhythm. 2023;24(1):4. doi: 10.1186/s42444-023-00086-2
  • Proietti M, Marzona I, Vannini T, et al. Long-term Relationship between atrial fibrillation, multimorbidity and oral anticoagulant drug use. Mayo Clin Proc. 2019;94(12):2427–2436. doi: 10.1016/j.mayocp.2019.06.012
  • Jaul E, Barron J. Characterizing the heterogeneity of aging: a vision for a staging system for aging [perspective]. Front Public Health. 2021;9:513557. doi: 10.3389/fpubh.2021.513557
  • Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm association (EHRA) of the ESC. Eur Heart J. 2020;42(5):373–498.
  • National Institute for Health and Care Excellence (NICE). Atrial fibrillation: diagnosis and management [Internet]. London: NICE; 2021 [ updated 2021 Jun 30; cited 2023 Aug 15]. (NICE guideline [NG196]). Available from: https://www.nice.org.uk/guidance/ng196
  • Mitchell A, Snowball J, Welsh TJ, et al. Prescribing of direct oral anticoagulants and warfarin to older people with atrial fibrillation in UK general practice: a cohort study. BMC Med. 2021;19(1):189. doi: 10.1186/s12916-021-02067-5
  • Ritchie LA, Harrison SL, Penson PE, et al. Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study. Br J Gen Pract. 2023;73(726):e43–e51. doi: 10.3399/BJGP.2022.0156
  • Osasu YM, Cooper R, Mitchell C. Patients’ and clinicians’ perceptions of oral anticoagulants in atrial fibrillation: a systematic narrative review and meta-analysis. BMC Fam Pract. 2021;22(1):254. doi: 10.1186/s12875-021-01590-x
  • Ding WY, Rivera-Caravaca JM, Marín F, et al. Number needed to treat for net effect of anticoagulation in atrial fibrillation: real-world vs. clinical-trial evidence. Br J Clin Pharmacol. 2022;88(1):282–289. doi: 10.1111/bcp.14961
  • Patti G, Lucerna M, Pecen L, et al. Thromboembolic risk, bleeding outcomes and effect of different antithrombotic strategies in very elderly patients with atrial fibrillation: a sub-analysis from the PREFER in AF (PREvention oF Thromboembolic events-European registry in atrial fibrillation). J Am Heart Assoc. 2017 Jul 23;6(7). doi: 10.1161/JAHA.117.005657
  • Shah SJ, Singer DE, Fang MC, et al. Net clinical benefit of oral anticoagulation among older adults with atrial fibrillation. Circulation. 2019;12(11):e006212. doi: 10.1161/CIRCOUTCOMES.119.006212
  • Ritchie LA, Lane DA, Lip GYH. Worldwide trends in antithrombotic therapy prescribing for atrial fibrillation: observations on the ‘transition era’ to non-vitamin K antagonist oral anticoagulants EP Europace. EP Europace. 2021;24(6):871–873. doi: 10.1093/europace/euab313
  • Grymonprez M, Simoens C, Steurbaut S, et al. Worldwide trends in oral anticoagulant use in patients with atrial fibrillation from 2010 to 2018: a systematic review and meta-analysis. EP Europace. 2022;24(6):887–898. doi: 10.1093/europace/euab303
  • Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus Warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–1151. doi: 10.1056/NEJMoa0905561
  • Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus Warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093–2104. doi: 10.1056/NEJMoa1310907
  • Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus Warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–992. doi: 10.1056/NEJMoa1107039
  • Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med. 2011;365(10):883–891. doi: 10.1056/NEJMoa1009638
  • Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–962. doi: 10.1016/S0140-6736(13)62343-0
  • Joint Formulary Committee. British National Formulary [Internet]. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; [updated 2023 Jun 28; cited 2023 Aug 10]. Available from: https://bnf.nice.org.uk/
  • Steinberg BA, Shrader P, Thomas L, et al. Off-label dosing of non-vitamin K antagonist oral anticoagulants and adverse outcomes: the ORBIT-AF II registry. J Am Coll Cardiol. 2016 Dec 20;68(24):2597–2604. doi: 10.1016/j.jacc.2016.09.966
  • Yao X, Shah ND, Sangaralingham LR, et al. Non-vitamin K antagonist oral anticoagulant dosing in patients with atrial fibrillation and renal dysfunction. J Am Coll Cardiol. 2017 Jun 13;69(23):2779–2790. doi: 10.1016/j.jacc.2017.03.600
  • Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. EP Europace. 2021;23(10):1612–1676. doi: 10.1093/europace/euab065
  • Halperin JL, Hankey GJ, Wojdyla DM, et al. Efficacy and safety of rivaroxaban compared with Warfarin among elderly patients with nonvalvular atrial fibrillation in the rivaroxaban Once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET AF). Circulation. 2014;130(2):138–146. doi: 10.1161/CIRCULATIONAHA.113.005008
  • Halvorsen S, Atar D, Yang H, et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J. 2014;35(28):1864–1872. doi: 10.1093/eurheartj/ehu046
  • Kato ET, Giugliano RP, Ruff CT, et al. Efficacy and safety of edoxaban in elderly patients with atrial fibrillation in the ENGAGE AF-TIMI 48 trial. J Am Heart Assoc. 2016;5(5):e003432. doi: 10.1161/JAHA.116.003432
  • Lauw MN, Eikelboom JW, Coppens M, et al. Effects of dabigatran according to age in atrial fibrillation. Heart. 2017;103(13):1015–1023. doi: 10.1136/heartjnl-2016-310358
  • Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with Warfarin in older and younger patients with atrial fibrillation. Circulation. 2011;123(21):2363–2372. doi: 10.1161/CIRCULATIONAHA.110.004747
  • Grymonprez M, Steurbaut S, De Backer TL, et al. Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-analysis. Front Pharmacol. 2020;11:583311. doi: 10.3389/fphar.2020.583311
  • Hohmann C, Hohnloser SH, Jacob J, et al. Non-vitamin K oral anticoagulants in comparison to phenprocoumon in geriatric and non-geriatric patients with non-valvular atrial fibrillation. Thromb Haemost. 2019;119(6):971–980. doi: 10.1055/s-0039-1683422
  • Wong JM, Maddox TM, Kennedy K, et al. Comparing Major Bleeding Risk in Outpatients With Atrial Fibrillation or Flutter by Oral Anticoagulant Type (from the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence Registry). Am J Cardiol. 2020;125(10):1500–1507. doi: 10.1016/j.amjcard.2020.02.028
  • Deitelzweig S, Keshishian A, Li X, et al. Comparisons between oral anticoagulants among older nonvalvular atrial fibrillation patients. J Am Geriatr Soc. 2019;67(8):1662–1671. doi: 10.1111/jgs.15956
  • Tan YY, Papez V, Chang WH, et al. Comparing clinical trial population representativeness to real-world populations: an external validity analysis encompassing 43 895 trials and 5 685 738 individuals across 989 unique drugs and 286 conditions in England. Lancet Healthy Longev. 2022;3(10):e674–e689. doi: 10.1016/S2666-7568(22)00186-6
  • Lin L, Lim WS, Zhou HJ, et al. Clinical and safety outcomes of oral antithrombotics for stroke prevention in atrial fibrillation: a systematic review and network meta-analysis. J Am Med Dir Assoc. 2015;16(12):.e1103.1–.e1103.19. doi: 10.1016/j.jamda.2015.09.008
  • Alcusky M, Tjia J, McManus DD, et al. Comparative safety and Effectiveness of direct-acting oral anticoagulants versus Warfarin: a National cohort study of nursing home residents. J Gen Intern Med. 2020;35(8):2329–2337. doi: 10.1007/s11606-020-05777-3
  • Specialist Pharmacy service. Medicines in compliance aids stability tool. [cited 2023 Aug 14]. Available from: https://www.sps.nhs.uk/home/tools/medicines-in-compliance-aids-stability-tool/
  • Bayer plc. Xarelto 20mg film-coated tablets summary of product characteristics. Electronic Medicines Compendium. 2023 [cited 2023 Aug 10]. Available from: https://www.medicines.org.uk/emc/product/2793/smpc
  • Daiichi Sankyo UK Limited. Lixiana 60mg film-coated tablets summary of product characteristics. Electronic Medicines Compendium. 2022 [cited 2023 Aug 10]. Available from: https://www.medicines.org.uk/emc/product/6905/smpc
  • Squibb-Pfizer B-M. Eliquis 2.5 mg film-coated tablets summary of product characteristics. Electronic Medicines Compendium. 2022 [cited 2023 Aug 10]. Available from: https://www.medicines.org.uk/emc/product/4756/smpc
  • Boehringer Ingelheim Limited. Pradaxa 110 mg hard capsules summary of product characteristics. Electronic Medicines Compendium. 2022 [cited 2023 Aug 10]. Available from: https://www.medicines.org.uk/emc/medicine/20760/SPC/Pradaxa+110+mg+hard+capsules/
  • Specialist Pharmacy service. Anticoagulant suggestions for adults with swallowing difficulties [ Published 1 July 2021, last updated 2023 Jul 5; cited 2023 Aug 14]. Available from: https://www.sps.nhs.uk/articles/anticoagulant-suggestions-for-adults-with-swallowing-difficulties/
  • Wrexham Maelor Hospital Pharmacy Department. The NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties. [cited 2023 Aug 10]. Available from: https://www.newtguidelines.com/
  • Lee ZX, Ang E, Lim XT, et al. Association of risk of dementia with direct oral anticoagulants versus Warfarin use in patients with non-valvular atrial fibrillation: a systematic review and meta-analysis. J Cardiovasc Pharmacol. 2021;77(1):22–31. doi: 10.1097/FJC.0000000000000925
  • Hohnloser SH, Fudim M, Alexander JH, et al. Efficacy and safety of apixaban versus Warfarin in patients with atrial fibrillation and extremes in body weight. Circulation. 2019;139(20):2292–2300. doi: 10.1161/CIRCULATIONAHA.118.037955
  • Boriani G, Ruff CT, Kuder JF, et al. Edoxaban versus Warfarin in patients with atrial fibrillation at the Extremes of body weight: an analysis from the ENGAGE AF-TIMI 48 trial. Thromb Haemost. 2021;121(2):140–149. doi: 10.1055/s-0040-1716540
  • Rao MP, Vinereanu D, Wojdyla DM, et al. Clinical outcomes and history of Fall in patients with atrial fibrillation Treated with oral anticoagulation: insights from the ARISTOTLE trial. Am J Med. 2018;131(3):269–275.e2. doi: 10.1016/j.amjmed.2017.10.036
  • Steffel J, Giugliano RP, Braunwald E, et al. Edoxaban versus Warfarin in atrial fibrillation patients at risk of falling: ENGAGE AF-TIMI 48 analysis. J Am Coll Cardiol. 2016;68(11):1169–1178. doi: 10.1016/j.jacc.2016.06.034
  • Mant J, Hobbs FD, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham atrial fibrillation treatment of the aged study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493–503. doi: 10.1016/S0140-6736(07)61233-1
  • Liu X, Huang H, Yu J, et al. Warfarin compared with aspirin for older Chinese patients with stable coronary heart diseases and atrial fibrillation complications. Int J Clin Pharmacol Ther. 2014;52(6):454–459. doi: 10.5414/CP201996
  • Rash A, Downes T, Portner R, et al. A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO). Age Ageing. 2007;36(2):151–156. doi: 10.1093/ageing/afl129
  • Burton C, Isles C, Norrie J, et al. The safety and adequacy of antithrombotic therapy for atrial fibrillation: a regional cohort study. Br J Gen Pract. 2006;56(530):697–702.
  • Gage BF, Boechler M, Doggette AL, et al. Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Stroke. 2000;31(4):822–827. doi: 10.1161/01.STR.31.4.822
  • Bai Y, Guo S-D, Deng H, et al. Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-regression analysis. Age Ageing. 2018;47(1):9–17. doi: 10.1093/ageing/afx103
  • Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–2734. doi: 10.1016/S0140-6736(17)31363-6
  • Johnston MC, Crilly M, Black C, et al. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Public Health. 2019;29(1):182–189. doi: 10.1093/eurpub/cky098
  • Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–439. doi: 10.1016/j.arr.2011.03.003
  • Proietti M, Esteve-Pastor MA, Rivera-Caravaca JM, et al. Relationship between multimorbidity and outcomes in atrial fibrillation. Exp Gerontol. 2021;153:111482. doi: 10.1016/j.exger.2021.111482
  • Dhamane AD, Ferri M, Keshishian A, et al. Effectiveness and safety of direct oral anticoagulants among patients with non-valvular atrial fibrillation and Multimorbidity. Adv Ther. 2023;40(3):887–902. doi: 10.1007/s12325-022-02387-9
  • Johnsen SP, Proietti M, Maggioni AP, et al. A multinational European network to implement integrated care in elderly multimorbid atrial fibrillation patients: the AFFIRMO consortium. Eur Heart J. 2022;43(31):2916–2918. doi: 10.1093/eurheartj/ehac265
  • EHRA-PATHS: addressing multimorbidity in elderly atrial fibrillation patients through interdisciplinary, patient-centred, systematic care pathways. [cited 2023 Sep 9]. Available from: https://ehra-paths.eu/
  • ACvd B, Geurts S, Ikram MA, et al. Bidirectional association between kidney function and atrial fibrillation: a population‐based cohort study. J Am Heart Assoc. 2022;11(10):e025303. doi: 10.1161/JAHA.122.025303
  • Magnocavallo M, Bellasi A, Mariani MV, et al. Thromboembolic and bleeding risk in atrial fibrillation patients with chronic kidney disease: role of anticoagulation therapy. J Clin Med. 2020;10(1):83. doi: 10.3390/jcm10010083
  • Ranbaxy (UK) limited a Sun Pharmaceutical Company. Warfarin 0.5mg tablets summary of product characteristics. Electronic Medicines Compendium. 2021 [cited 2023 Aug 10]. Available from: https://www.medicines.org.uk/emc/product/3064/smpc
  • Fazio G, Dentamaro I, Gambacurta R, et al. Safety of edoxaban 30 mg in elderly patients with severe renal impairment. Clin Drug Investig. 2018;38(11):1023–1030. doi: 10.1007/s40261-018-0693-6
  • Stanifer JW, Pokorney SD, Chertow GM, et al. Apixaban versus Warfarin in patients with atrial fibrillation and advanced chronic kidney disease. Circulation. 2020;141(17):1384–1392. doi: 10.1161/CIRCULATIONAHA.119.044059
  • Weir MR, Ashton V, Moore KT, et al. Rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and stage IV-V chronic kidney disease. Am Heart J. 2020;223:3–11. doi: 10.1016/j.ahj.2020.01.010
  • Ott A, Breteler MM, de Bruyne MC, et al. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997;28(2):316–321. doi: 10.1161/01.STR.28.2.316
  • Garcia-Ptacek S, Contreras Escamez B, Zupanic E, et al. Prestroke mobility and dementia as predictors of stroke outcomes in patients over 65 years of age: a cohort study from the Swedish dementia and stroke registries. J Am Med Dir Assoc. 2018;19(2):154–161. doi: 10.1016/j.jamda.2017.08.014
  • Cheng W, Liu W, Li B, et al. Relationship of anticoagulant therapy with cognitive impairment among patients with atrial fibrillation: a meta-analysis and systematic review. J Cardiovasc Pharmacol. 2018;71(6):380–387. doi: 10.1097/FJC.0000000000000575
  • Moffitt P, Lane DA, Park H, et al. Thromboprophylaxis in atrial fibrillation and association with cognitive decline: systematic review. Age Ageing. 2016;45(6):767–775. doi: 10.1093/ageing/afw104
  • Wang W, Fan W, Su Y, et al. A comparison of the effects of NOAC and VKA therapy on the incidence of dementia in patients with atrial fibrillation: a systematic review and meta-analysis. Clin Cardiol. 2023;46(8):866–876. doi: 10.1002/clc.24076
  • Mongkhon P, Naser AY, Fanning L, et al. Oral anticoagulants and risk of dementia: a systematic review and meta-analysis of observational studies and randomized controlled trials. Neurosci Biobehav Rev. 2019;96:1–9. doi: 10.1016/j.neubiorev.2018.10.025
  • Chen LY, Norby FL, Gottesman RF, et al. Association of atrial fibrillation with cognitive decline and dementia over 20 years: the ARIC-NCS (atherosclerosis risk in communities neurocognitive study). J Am Heart Assoc. 2018;7(6):e007301. doi: 10.1161/JAHA.117.007301
  • Papanastasiou CA, Theochari CA, Zareifopoulos N, et al. Atrial fibrillation is associated with cognitive impairment, all-cause dementia, vascular dementia, and Alzheimer’s disease: a systematic review and meta-analysis. J Gen Intern Med. 2021;36(10):3122–3135. doi: 10.1007/s11606-021-06954-8
  • van Veluw SJ, Shih AY, Smith EE, et al. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol. 2017;16(9):730–740. doi: 10.1016/S1474-4422(17)30196-5
  • Madhavan M, Hu TY, Gersh BJ, et al. Efficacy of Warfarin anticoagulation and incident dementia in a community-based cohort of atrial fibrillation. Mayo Clin Proc. 2018;93(2):145–154. doi: 10.1016/j.mayocp.2017.09.021
  • Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. Eur Heart J. 2018;39(6):453–460. doi: 10.1093/eurheartj/ehx579
  • Mongkhon P, Fanning L, Lau WCY, et al. Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: a population-based cohort study. Heart Rhythm. 2020;17(5 Pt A):706–713. doi: 10.1016/j.hrthm.2020.01.007
  • Ding M, Fratiglioni L, Johnell K, et al. Atrial fibrillation, antithrombotic treatment, and cognitive aging: a population-based study. Neurology. 2018;91(19):e1732–e1740. doi: 10.1212/WNL.0000000000006456
  • Wong CK, Huang D, Zhou M, et al. Antithrombotic therapy and the risk of new-onset dementia in elderly patients with atrial fibrillation. Postgrad Med J. 2022;98(1156):98–103. doi: 10.1136/postgradmedj-2020-137916
  • Kim D, Yang PS, Yu HT, et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort. Eur Heart J. 2019;40(28):2313–2323. doi: 10.1093/eurheartj/ehz386
  • Bezabhe WM, Bereznicki LR, Radford J, et al. Oral anticoagulant treatment and the risk of dementia in patients with atrial fibrillation: a population‐based cohort study. J Am Heart Assoc. 2022;11(7):e023098. doi: 10.1161/JAHA.121.023098
  • Field TS, Weijs B, Curcio A, et al. Incident atrial fibrillation, dementia and the role of anticoagulation: a population-based cohort study. Thromb Haemost. 2019;119(6):981–991. doi: 10.1055/s-0039-1683429
  • Barber M, Tait RC, Scott J, et al. Dementia in subjects with atrial fibrillation: hemostatic function and the role of anticoagulation. J Thromb Haemost. 2004;2(11):1873–1878. doi: 10.1111/j.1538-7836.2004.00993.x
  • Douiri A, McKevitt C, Emmett ES, et al. Long-term effects of secondary prevention on cognitive function in stroke patients. Circulation. 2013;128(12):1341–1348. doi: 10.1161/CIRCULATIONAHA.113.002236
  • Viscogliosi G, Ettorre E, Chiriac IM. Dementia correlates with anticoagulation underuse in older patients with atrial fibrillation. Arch Gerontol Geriatr. 2017;72:108–112. doi: 10.1016/j.archger.2017.05.014
  • Liao M, Lin L, Lin J. Did warfarin and antiplatelet reduce the incidence of dementia in patients with atrial fibrillation: a nationwide cohort study. Europace. 2013;15(2):923.
  • Meranus D, Kukull W. P3–161: antithrombotic medication use and dementia incidence among people with mild cognitive impairment and atrial fibrillation. Alzheimer’s Dementia. 2013;9(4S_Part_15):612. doi: 10.1016/j.jalz.2013.05.1233
  • Cadogan SL, Powell E, Wing K, et al. Anticoagulant prescribing for atrial fibrillation and risk of incident dementia. Heart. 2021;107(23):1898–1904. doi: 10.1136/heartjnl-2021-319672
  • Søgaard M, Skjøth F, Jensen M, et al. Nonvitamin K antagonist oral anticoagulants versus Warfarin in atrial fibrillation patients and risk of dementia: a nationwide propensity-weighted cohort study. J Am Heart Assoc. 2019;8(11):e011358. doi: 10.1161/JAHA.118.011358
  • Lee SR, Choi EK, Park SH, et al. Comparing Warfarin and 4 direct oral anticoagulants for the risk of dementia in patients with atrial fibrillation. Stroke. 2021;52(11):3459–3468. doi: 10.1161/STROKEAHA.120.033338
  • Hsu JY, Liu PP, Liu AB, et al. Lower risk of dementia in patients with atrial fibrillation taking non-vitamin K antagonist oral anticoagulants: a nationwide population-based cohort study. J Am Heart Assoc. 2021;10(5):e016437. doi: 10.1161/JAHA.120.016437
  • Chen N, Lutsey PL, MacLehose RF, et al. Association of oral anticoagulant type with risk of dementia among patients with nonvalvular atrial fibrillation. J Am Heart Assoc. 2018;7(21):e009561. doi: 10.1161/JAHA.118.009561
  • Jacobs V, May HT, Bair TL, et al. Long-term population-based cerebral ischemic event and cognitive outcomes of direct oral anticoagulants compared with Warfarin among long-term anticoagulated patients for atrial fibrillation. Am J Cardiol. 2016;118(2):210–214. doi: 10.1016/j.amjcard.2016.04.039
  • Jacobs V, Woller SC, Stevens S, et al. Time outside of therapeutic range in atrial fibrillation patients is associated with long-term risk of dementia. Heart Rhythm. 2014;11(12):2206–2213. doi: 10.1016/j.hrthm.2014.08.013
  • Bunch TJ, May HT, Bair TL, et al. Atrial fibrillation patients treated with long-term Warfarin anticoagulation have higher rates of all dementia types compared with patients receiving long-term Warfarin for other indications. J Am Heart Assoc. 2016;5(7):e003932. doi: 10.1161/JAHA.116.003932
  • Ritchie LA, Oke OB, Harrison SL, et al. Prevalence of atrial fibrillation and outcomes in older long-term care residents: a systematic review. Age Ageing. 2020;50(3):744–757. doi: 10.1093/ageing/afaa268
  • Savelieva I, Fumagalli S, Kenny RA, et al. EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), And Cardiac Arrhythmia Society Of Southern Africa (CASSA). EP Europace. 2023;25(4):1249–1276.
  • Zathar Z, Karunatilleke A, Fawzy AM, et al. Atrial fibrillation in older people: concepts and controversies. Front Med. 2019;6:175. doi: 10.3389/fmed.2019.00175
  • Diener H-C, Connolly SJ, Ezekowitz MD, et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurol. 2010;9(12):1157–1163. doi: 10.1016/S1474-4422(10)70274-X
  • Easton JD, Lopes RD, Bahit MC, et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of the ARISTOTLE trial. Lancet Neurol. 2012;11(6):503–511. doi: 10.1016/S1474-4422(12)70092-3
  • Hankey GJ, Patel MR, Stevens SR, et al. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet Neurol. 2012;11(4):315–322. doi: 10.1016/S1474-4422(12)70042-X
  • Ntaios G, Papavasileiou V, Diener HC, et al. Nonvitamin-K-antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized controlled trials. Int J Stroke. 2017;12(6):589–596. doi: 10.1177/1747493017700663
  • Guo Z, Ding X, Ye Z, et al. Non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with previous stroke or intracranial hemorrhage: a systematic review and meta-analysis of observational studies. Clin Cardiol. 2021;44(7):917–924. doi: 10.1002/clc.23647
  • Komen JJ, Forslund T, Mantel-Teeuwisse AK, et al. Association of preceding antithrombotic therapy in atrial fibrillation patients with ischaemic stroke, intracranial haemorrhage, or gastrointestinal bleed and mortality. Eur Heart J Cardiovasc Pharmacother. 2021;7(1):3–10. doi: 10.1093/ehjcvp/pvz063
  • Larsen TB, Rasmussen LH, Gorst-Rasmussen A, et al. Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: a nationwide cohort study. Am J Med. 2014;127(12):1172–8.e5. doi: 10.1016/j.amjmed.2014.07.023
  • Xian Y, Xu H, O’Brien EC, et al. Clinical Effectiveness of direct oral anticoagulants vs Warfarin in older patients with atrial fibrillation and ischemic stroke: findings from the patient-centered research into outcomes stroke patients prefer and Effectiveness research (PROSPER) study. JAMA Neurol. 2019;76(10):1192–1202. doi: 10.1001/jamaneurol.2019.2099
  • Seiffge DJ, Paciaroni M, Wilson D, et al. Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. Ann Neurol. 2019;85(6):823–834. doi: 10.1002/ana.25489
  • Tsai CT, Liao JN, Chen SJ, et al. Non-vitamin K antagonist oral anticoagulants versus warfarin in AF patients ≥ 85 years. Eur J Clin Invest. 2021;51(6):e13488. doi: 10.1111/eci.13488
  • Yang L, Brooks MM, Glynn NW, et al. Real-world direct comparison of the Effectiveness and safety of apixaban, dabigatran, rivaroxaban, and Warfarin in medicare beneficiaries with atrial fibrillation. Am J Cardiol. 2020;126:29–36. doi: 10.1016/j.amjcard.2020.03.034
  • Coleman CI, Peacock WF, Bunz TJ, et al. Effectiveness and safety of apixaban, dabigatran, and rivaroxaban versus Warfarin in patients with nonvalvular atrial fibrillation and previous stroke or transient ischemic attack. Stroke. 2017;48(8):2142–2149. doi: 10.1161/STROKEAHA.117.017474
  • Nielsen PB, Skjøth F, Søgaard M, et al. Non-vitamin K antagonist oral anticoagulants versus Warfarin in atrial fibrillation patients with intracerebral hemorrhage. Stroke. 2019;50(4):939–946. doi: 10.1161/STROKEAHA.118.023797
  • Park J, Lee S-R, Choi E-K, et al. Effectiveness and safety of direct oral anticoagulant for secondary prevention in Asians with atrial fibrillation. J Clin Med. 2019;8(12):2228. doi: 10.3390/jcm8122228
  • Lee SR, Choi EK, Kwon S, et al. Oral anticoagulation in Asian patients with atrial fibrillation and a history of intracranial hemorrhage. Stroke. 2020;51(2):416–423. doi: 10.1161/STROKEAHA.119.028030
  • Polymeris AA, Macha K, Paciaroni M, et al. Oral anticoagulants in the oldest old with recent stroke and atrial fibrillation. Ann Neurol. 2022;91(1):78–88. doi: 10.1002/ana.26267
  • Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet. 2013;381(9868):752–762. doi: 10.1016/S0140-6736(12)62167-9
  • Wilkinson C, Todd O, Clegg A, et al. Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis. Age Ageing. 2019;48(2):196–203. doi: 10.1093/ageing/afy180
  • Oqab Z, Pournazari P, Sheldon RS. What is the impact of frailty on prescription of anticoagulation in elderly patients with atrial fibrillation? A systematic review and meta-analysis. J Atr Fibrillation. 2018;10(6):1870. doi: 10.4022/jafib.1870
  • Proietti M, Romiti GF, Vitolo M, et al. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing. 2022;51(8). doi: 10.1093/ageing/afac192
  • Villani ER, Tummolo AM, Palmer K, et al. Frailty and atrial fibrillation: a systematic review. Eur J Intern Med. 2018;56:33–38. doi: 10.1016/j.ejim.2018.04.018
  • Proietti M, Romiti GF, Raparelli V, et al. Frailty prevalence and impact on outcomes in patients with atrial fibrillation: a systematic review and meta-analysis of 1,187,000 patients. Ageing Res Rev. 2022;79:101652. doi: 10.1016/j.arr.2022.101652
  • Ekerstad N, Karlsson T, Söderqvist S, et al. Hospitalized frail elderly patients – atrial fibrillation, anticoagulation and 12 months’ outcomes. Clin Interventions Aging. 2018;13:749–756. doi: 10.2147/CIA.S159373
  • Martinez BK, Sood NA, Bunz TJ, et al. Effectiveness and safety of apixaban, dabigatran, and rivaroxaban versus Warfarin in frail patients with nonvalvular atrial fibrillation. J Am Heart Assoc. 2018;7(8):e008643. doi: 10.1161/JAHA.118.008643
  • Kajsa E, Katarina W, Sten L, et al. Screening for frailty among older emergency department visitors: validation of the new FRESH-screening instrument. BMC Emerg Med. 2016;16(1):27. doi: 10.1186/s12873-016-0087-0
  • Segal JB, Chang HY, Du Y, et al. Development of a claims-based frailty Indicator Anchored to a well-established frailty phenotype. Med Care. 2017;55(7):716–722. doi: 10.1097/MLR.0000000000000729
  • Joosten LPT, van Doorn S, van de Ven PM, et al. Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist oral anticoagulant in frail older patients with atrial fibrillation: results of the FRAIL-AF randomized controlled trial. Circulation. 2023. Online ahead of print. doi: 10.1161/CIRCULATIONAHA.123.066485
  • Steverink N, Slaets J, Schuurmans H, et al. Measuring frailty: developing and testing the GFI (Groningen frailty Indicator). Gerontologist. 2001;41:236–237.
  • Park CS, Choi EK, Kim HM, et al. Increased risk of major bleeding in underweight patients with atrial fibrillation who were prescribed non-vitamin K antagonist oral anticoagulants. Heart Rhythm. 2017;14(4):501–507. doi: 10.1016/j.hrthm.2016.12.036
  • Barba R, Marco J, MartÍN-Alvarez H, et al. The influence of extreme body weight on clinical outcome of patients with venous thromboembolism: findings from a prospective registry (RIETE). J Thromb Haemost. 2005;3(5):856–862. doi: 10.1111/j.1538-7836.2005.01304.x
  • Malik AH, Yandrapalli S, Shetty S, et al. Impact of weight on the efficacy and safety of direct-acting oral anticoagulants in patients with non-valvular atrial fibrillation: a meta-analysis. EP Europace. 2020;22(3):361–367. doi: 10.1093/europace/euz361
  • Feeney JM, Santone E, DiFiori M, et al. Compared to warfarin, direct oral anticoagulants are associated with lower mortality in patients with blunt traumatic intracranial hemorrhage: a TQIP study. J Trauma Acute Care Surg. 2016;81(5):843–848. doi: 10.1097/TA.0000000000001245
  • Wilson L, Boase K, Nelson LD, et al. A manual for the glasgow outcome scale-extended interview. J Neurotrauma. 2021;38(17):2435–2446. doi: 10.1089/neu.2020.7527
  • Scotti P, Séguin C, BWY L, et al. Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes. J Neurosurg. 2019;133:1–10.
  • Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi: 10.1186/s12877-017-0621-2
  • Wang Y, Singh S, Bajorek B. Old age, high risk medication, polypharmacy: a ‘trilogy’ of risks in older patients with atrial fibrillation. Pharm Pract (Granada). 2016;14(2):706. doi: 10.18549/PharmPract.2016.02.706
  • Celine G, Karin N-H, Debra R, et al. Polypharmacy and health outcomes in atrial fibrillation: a systematic review and meta-analysis. Open Heart. 2020;7(1):e001257. doi: 10.1136/openhrt-2020-001257
  • Camacho EM, Lip GYH. Estimating the impact of implementing an integrated care management approach with Atrial fibrillation Better Care (ABC) pathway for patients with atrial fibrillation in England from 2020-2040. Eur Heart J Qual Care Clin Outcomes;2023. doi: 10.1093/ehjqcco/qcad055
  • Datapharm. Electronic Medicines Compendium. [cited 2023 Oct 16]. Available from: https://www.medicines.org.uk/emc
  • de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf. 2013;4(4):147–154. doi: 10.1177/2042098613486829
  • Lane DA, Lip GYH. Stroke and bleeding risk stratification in atrial fibrillation: a critical appraisal. Eur Heart J Suppl. 2020;22(Supplement_O):O14–O27. doi: 10.1093/eurheartj/suaa178