Risk of bleeding in very old atrial fibrillation patients on warfarin: Relationship with ageing and CHADS2 score

Daniela Poli, Emilia Antonucci, Rossella Marcucci, Cinzia Fatini, Brunetto Alterini, Lucia Mannini, Michela Falciani, Rosanna Abbate, Gian Franco Gensini, Domenico Prisco

Research output: Contribution to journalArticle

Abstract

Aims: In atrial fibrillation (AF) patients, age ≥ 75 years is one of the major risk factors for stroke. However, it is not clear if an upper limit for the indication to OAT exists. Methods and results: For this reason, we performed a prospective study on 290 AF patients on OAT aged ≥ 75 years (median age 82 years, total follow-up period 814 pt/years) followed by our Anticoagulation Clinic. Seventeen major bleeding events were recorded (rate 2.1 × 100 pt/years), 11 of which cerebral (1.35 × 100 pt/years). The occurrence of major bleedings was associated with history of previous TIA or stroke [OR 3.4 (1.1-12.5), p = 0.01] and with diabetes [OR 4.4 (1.3-14.7) p = 0.01]. We found a trend to a progressive increase in the rate of bleeding risk with the increase of the CHADS2 score: patients with score 4-6 showed a rate of 3.4 × 100 pt/years with respect to 1.5 × 100 pt/years of patients with lower score. Number Needed to Harm (NNH) was calculated in relation to different classes of age (75-89, 80-84, ≥ 85 years) and to CHADS2 score. For patients in CHADS2 score 1-3 NNH remained stable across the different age classes. Instead for patients in CHADS2 score 4-6, NNH varied among the 3 groups of ages, reaching a value of 10 in patients ≥ 85 years. Conclusion: Our data suggest that: 1) in AF patients older than 75 years with CHADS2 score 1-3 the risk of bleeding is low, 2) in AF patients > 85 years with CHADS24-6 the risk of bleeding is high so that the use of OAT should be highly individualised.

Original languageEnglish
Pages (from-to)347-352
Number of pages6
JournalThrombosis Research
Volume121
Issue number3
DOIs
Publication statusPublished - 2007

Keywords

  • Atrial fibrillation
  • Bleeding risk
  • CHADS score
  • Old patients
  • Oral anticoagulant therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Hematology

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    Poli, D., Antonucci, E., Marcucci, R., Fatini, C., Alterini, B., Mannini, L., Falciani, M., Abbate, R., Gensini, G. F., & Prisco, D. (2007). Risk of bleeding in very old atrial fibrillation patients on warfarin: Relationship with ageing and CHADS2 score. Thrombosis Research, 121(3), 347-352. https://doi.org/10.1016/j.thromres.2007.05.014