Introduction of Non-Vitamin K Antagonist Anticoagulants Strongly Increased the Rate of Anticoagulation in Hospitalized Geriatric Patients with Atrial Fibrillation.

Background: The benefit of anticoagulative treatment to prevent thromboembolism has been established in patients with atrial fibrillation and flutter of all age groups. Traditionally, anticoagulation was underused in geriatric patients with atrial fibrillation and flutter.

Objective: The aim of this study was to assess whether the broad introduction of non-vitamin K antagonist oral anticoagulants into clinical medicine has changed the rate of older patients treated with anticoagulants for atrial fibrillation and flutter.

Methods: Hospitalized geriatric patients treated in 2015 were retrospectively studied for the presence of atrial fibrillation and flutter and the use or non-use of anticoagulation. The risk of stroke and the indication for permanent anticoagulation were assessed using the CHADS-VASc score.

Results: Five hundred and twelve of 1320 patients showed a clear indication for therapeutic anticoagulation (38.8%). Of these, 431 patients (84.2%) had long-standing persistent (> 1 year)/permanent atrial fibrillation and flutter or paroxysmal/persistent (> 7 days) atrial fibrillation and flutter as well as CHADS-VASc scores of ≥ 2 in men and ≥ 3 in women. In this group, 378 patients (87.7%) received anticoagulative treatment. Of all patients anticoagulated for atrial fibrillation and flutter, 221 received non-vitamin K antagonist oral anticoagulants (58.5%), 176 received apixaban (46.6%), 32 received rivaroxaban (8.5%), and 13 received dabigatran (3.4%). One hundred and seven patients received the vitamin K antagonist phenprocoumon (28.3%) and 50 patients received high-dose low-molecular-weight heparins (13.2%). In 21 patients (5.6% of all anticoagulated patients with atrial fibrillation and flutter), hemorrhagic complications were documented. Eleven complications (52.4; 5.0% of all patients treated with non-vitamin K antagonist oral anticoagulants) occurred during treatment with non-vitamin K antagonist oral anticoagulants, four (19.0%) during anticoagulation with phenprocoumon and six (28.6%) during treatment with low-molecular-weight heparins. No intracranial hemorrhages and no fatal bleeding events occurred.

Conclusion: The introduction of non-vitamin K antagonist oral anticoagulants and an increased awareness of their benefits led to an increased use of anticoagulation from 52.8% (2011) to 87.7% (2015) in geriatric patients with atrial fibrillation and flutter at our institution.