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Age-Dependent Anticoagulant Therapy for Atrial Fibrillation Patients with Intermediate Risk of Ischemic Stroke: A Nationwide Population-Based StudyFunding This research was supported by a grant from the Ministry of Education, Science and Technology (NRF- 2018R1D1A1A09083902) to M.H.K., as well as support from the Ministry of Education (NRF-2017R1D1A3B03035713) to S.Y.C.
Background Although older age is one of the most important risk factors for stroke in atrial fibrillation (AF), it is unclear whether an age threshold exists for which oral anticoagulants (OACs) are beneficial for intermediate-risk AF patients. We sought to investigate the age-dependency of OAC for ischemic stroke in intermediate-risk AF patients.
Methods We enrolled 34,701 AF patients (males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2) using the Korean National Health Insurance Service database. The clinical endpoint was the occurrence of ischemic stroke and a composite outcome (ischemic stroke + major bleeding + all-cause death).
Results In AF patients aged ≥ 55 years, OAC therapy was associated with a lower risk of ischemic stroke compared with non-OAC treatment in males (55–59 years: hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.61–0.98, p = 0.038, 60–64 years: HR 0.78, 95% CI 0.61–0.96, p = 0.029, and 65–74 years: HR 0.66, 95% CI 0.49–0.84, p = 0.011) and females (55–59 years: HR 0.76, 95% CI 0.58–0.96, p = 0.027, 60–64 years: HR 0.73, 95% CI 0.55–0.93, p = 0.017, and 65–74 years: HR 0.69, 95% CI 0.51–0.87, p = 0.013). OAC was associated with a lower risk for the composite outcome compared with non-OAC for male and female patients aged ≥ 55 years.
Conclusion Age is an important determinant of ischemic stroke and composite outcome in intermediate-risk AF patients. The benefit of OAC therapy for these AF patients appears to have an age threshold (age ≥ 55 years).
* The editorial process for this paper was fully handled by Prof Christian Weber, Editor-in-Chief.
Received: 07 September 2020
Accepted: 08 December 2020
11 December 2020 (online)
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