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Age as a Risk Factor for Stroke in Atrial Fibrillation Patients
Open accessAbstract
The prevalence of atrial fibrillation (AF) is related to age and is projected to rise exponentially as the population ages and the prevalence of cardiovascular risk factors increases. The risk of ischemic stroke is significantly increased in AF patients, and there is evidence of a graded increased risk of stroke associated with advancing age. Oral anticoagulation (OAC) is far more effective than antiplatelet agents at reducing stroke risk in patients with AF. Therefore, increasing numbers of elderly patients are candidates for, and could benefit from, the use of anticoagulants. However, elderly people with AF are less likely to receive OAC therapy. This is mainly due to concerns about a higher risk of OAC-associated hemorrhage in the elderly population. Until recently, older patients were under-represented in randomized controlled trials of OAC versus placebo or antiplatelet therapy, and therefore the evidence base for the value of OAC in the elderly population was not known. However, analyses of the available trial data indicate that the expected net clinical benefit of warfarin therapy is highest among patients with the highest untreated risk for stroke, which includes the oldest age category. An important caveat with warfarin treatment is maintenance of a therapeutic international normalized ratio, regardless of the age of the patient, where time in therapeutic range should be > or =65%. Therefore, age alone should not prevent prescription of OAC in elderly patients, given an appropriate stroke and bleeding risk stratification.
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“Elderly AF patients are at higher risk of stroke and thus are more likely to benefit from OAC than younger patients, 841”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [841]
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Metadata
- Authors
- Marinigh, R., Lip, G. Y. H., Fiotti, N., Giansante, C., & Lane, D. A.
- Affiliations
- University of Trieste (IT)
- Birmingham City Hospital (GB)
- Corresponding author
- Lane, Deirdre A.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 56
- Issue
- 11
- Pages
- 827-837
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W152570996
- Cited by
- 232
- References
- 86
- Citations by year
- 2026: 3 · 2025: 14 · 2024: 13 · 2023: 10 · 2022: 12 · 2021: 15 · 2020: 14 · 2019: 19 · 2018: 15 · 2017: 16 · 2016: 18 · 2015: 14 · 2014: 10 · 2013: 16 · 2012: 19
- FWCI
- 3.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Bayer Healthcare
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, ischemic stroke, age as risk factor, oral anticoagulation, warfarin, antiplatelet therapy, bleeding risk, elderly patients, stroke risk stratification, time in therapeutic range, underrepresentation in clinical trials
- MeSH terms
- Age Factors, Atrial Fibrillation, Fibrinolytic Agents, Humans, Risk Factors, Treatment Outcome, Risk Assessment, Stroke
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