ArticleHeart (British Cardiac Society)2013
Thromboprophylaxis of elderly patients with AF in the UK: an analysis using the General Practice Research Database (GPRD) 2000-2009.
Article in Heart (British Cardiac Society), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
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Who cites it
38 citing papers in PubMed.
- Atrial fibrillation and comorbidities: Clinical characteristics and antithrombotic treatment in GLORIA-AF.PloS one · 2021Trial
- Polypharmacy and effects of apixaban versus warfarin in patients with atrial fibrillation: post hoc analysis of the ARISTOTLE trial.BMJ (Clinical research ed.) · 2016Trial
- Efficacy and Safety of Edoxaban in Elderly Patients With Atrial Fibrillation in the ENGAGE AF-TIMI 48 Trial.Journal of the American Heart Association · 2016Trial
- Secondary Prevention of AFAIS: Deploying Traditional Regression, Machine Learning, and Deep Learning Models to Validate and Update CHA2DS2-VASc for 90-Day Recurrence.Journal of clinical medicine · 2025Article
- External Validation of the Charlson Comorbidity Index-based Model for Survival Prediction in Thai Patients Diagnosed with Dementia.BMC geriatrics · 2024Article
- Prevalence of oral anticoagulant use among people with and without Alzheimer's disease.BMC geriatrics · 2022Article
- Anticoagulation Control in Older Atrial Fibrillation Patients Receiving Vitamin K Antagonist Therapy for Stroke Prevention.International journal of clinical practice · 2022Article
- Stroke prevention strategies in high-risk patients with atrial fibrillation.Nature reviews. Cardiology · 2021Review
- Right drug, wrong dosage: insights from the PAVE-AF antithrombotic study in older patients with atrial fibrillation.Journal of thrombosis and thrombolysis · 2021Observational
- Failure of non-vitamin K antagonist oral anticoagulants in preventing stroke in elderly patient: a case report of multiple strokes on standard of care treatment for atrial fibrillation.Archive of clinical cases · 2021Article
- Prescription of oral anticoagulants and antiplatelets for stroke prophylaxis in atrial fibrillation: nationwide time series ecological analysis.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2020Article
- Trends in oral anticoagulant prescribing in individuals with type 2 diabetes mellitus: a population-based study in the UK.BMJ open · 2020Article
- Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies.Journal of clinical medicine · 2019Review
- Rate of anticoagulant use, and factors associated with not prescribing anticoagulant in older Thai adults with non-valvular atrial fibrillation: A multicenter registry.Journal of geriatric cardiology : JGC · 2019Article
- Influence of frailty on anticoagulant prescription and clinical outcomes after 1-year follow-up in hospitalised older patients with atrial fibrillation.Internal and emergency medicine · 2019Observational
- Optimal long-term antithrombotic management of atrial fibrillation: life cycle management.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2018Review
- Arrhythmias in Patients ≥80 Years of Age: Pathophysiology, Management, and Outcomes.Journal of the American College of Cardiology · 2018Review
- Under-recording of hospital bleeding events in UK primary care: a linked Clinical Practice Research Datalink and Hospital Episode Statistics study.Clinical epidemiology · 2018Article
- Article
- Antithrombotics in trauma: management strategies in the older patients.Journal of blood medicine · 2017Review
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess use of thromboprophylaxis in UK general practise among patients with atrial fibrillation (AF); to investigate whether elderly patients are less likely to receive anticoagulation therapy than younger patients.
designRetrospective cohort study
settingUK General Practice Research Database (GPRD) PATIENTS: Aged ≥60 years with a new diagnosis of AF (2000-2009).
interventionsNone.
main outcome measuresThe main outcome measure was initiation of warfarin in the first year following diagnosis. Patients were categorised by stroke risk (CHADS(2) score) and bleeding risk (HAS-BLED score).
results81 381 patients were identified (21% aged 60-69 years, 37% aged 70-79 years, 42% aged 80+ years). Patients aged 80+ years were significantly less likely to be initiated on warfarin than younger patients, adjusted for gender, practice and comorbidities; 32% of patients aged 80+ years received warfarin compared with 57% aged 60-69 years (p<0.0001), and 55% aged 70-79 years (p<0.0001). For all strata of CHADS(2)/HASBLED scores, patients aged 80+ years were significantly less likely to be treated with warfarin than younger patients. Logistic regression showed that female sex, low Basal Metabolic Index (BMI), age over 80 years, increasing HAS-BLED score and dementia were independently associated with reduced use of warfarin. Stroke/Transient Ischaemic Attack (TIA), hypertension, heart failure and left ventricular systolic dysfunction were associated with increased use. Patients with HAS-BLED>CHADS(2) were less likely to be initiated on warfarin. Higher CHADS(2) scores were associated with increased anticoagulation use.
conclusionsAnticoagulation is being under-used in patients with AF aged 80+ years, even after taking into account increased bleeding risk in this age group.
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