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Clinical impact of oral anticoagulation among octogenarians with atrial fibrillation and anaemia

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Abstract

Our study aimed to describe the efficacy and safety of oral anticoagulation (OAC) use in elderly patients (> or = 80 years-old) with atrial fibrillation (AF) and concomitant anaemia. Data for this study were sourced from AF Research Database (NCT03760874). AF patients aged ≥ 80 who received OAC treatment, both direct oral anticoagulant (DOAC) and vitamin K antagonist (VKA) were selected. Participants were categorized as anaemic and non-anaemic. The primary outcome was the occurrence of overall bleeding. The primary effectiveness outcome was the occurrence of thromboembolic events (a composite of ischemic stroke, transient ischemic attack and systemic embolism). The secondary safety and effectiveness outcomes were major, minor bleedings and mortality, respectively. A total of 958 patients were included in the study, 120 (12.5%) were anaemic; among them, 93 patients (76.6%) were treated with VKAs and 28 (23.3%) with DOAC. Kaplan-Meier curves for major bleedings showed significant differences between anemic- and non-anemic groups (log-rank p = 0.005). In multivariate analysis, among patients on OAC, anaemia was independently associated with major bleeding (HR 2.36; 95% IC 1.2–4.4; p = 0.006), intracranial hemorrhages (HR 3.81; 95% IC 1.35–10.7; p = 0.01) and minor bleedings (HR 2.40; 95%IC 1.1–5.2; p = 0.02); these associations were not confirmed in the DOACs subgroup. No difference in survival was shown between anaemic- and non-anaemic groups and among anaemic patients, between DOAC and VKAs subgroups. Anaemic octogenarians with AF on OAC therapy showed a significantly increased risk of major bleedings, in particular ICH, and mortality compared to non-anaemic.

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Data availability

The data that support the findings of this study are available from the corresponding author, V.R., upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Cardiology Unit, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Andreina Carbone, Roberta Bottino, Emilio Attena, Paolo Golino & Vincenzo Russo

  2. Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy

    Valentina Parisi & Maddalena Conte

  3. Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Italy

    Antonello D’Andrea

  4. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Egidio Imbalzano

  5. Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”— Monaldi Hospital, P.zzale Ettore Ruggeri, 80131, Naples, Italy

    Vincenzo Russo

Authors
  1. Andreina Carbone
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  2. Roberta Bottino
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  3. Emilio Attena
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  4. Valentina Parisi
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  5. Maddalena Conte
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  6. Antonello D’Andrea
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  7. Egidio Imbalzano
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  8. Paolo Golino
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  9. Vincenzo Russo
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Contributions

AC and VR: designed the research and wrote the paper; EA, MC, VP, AD’A, RB: collected data; AC: performed statistical analysis; EI and PG: reviewed the paper.

Corresponding author

Correspondence to Vincenzo Russo.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committees of Monaldi Hospital, Naples; University of Campania “Luigi Vanvitelli”, Naples; Maggiore Hospital, Trieste (NCT03760874).

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Informed consent was obtained from all individual participants included in the study.

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Carbone, A., Bottino, R., Attena, E. et al. Clinical impact of oral anticoagulation among octogenarians with atrial fibrillation and anaemia. J Thromb Thrombolysis 55, 222–227 (2023). https://doi.org/10.1007/s11239-022-02740-3

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  • DOI: https://doi.org/10.1007/s11239-022-02740-3

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