Background and purpose: despite large randomised trials that
demonstrated the efficacy of oral anticoagulants in the primary and
secondary prevention of stroke in patients with non-valvular atrial
fibrillation (AF), anticoagulation therapy remains largely under-used in
older patients, who are at risk of first ever or recurrent stroke. The
aim of the present study was to assess the influence of anticoagulation
therapy on long-term prognosis in the oldest old stroke patients with AF
after adjusting for baseline risk factors.
Methods: we evaluated prospectively a consecutive series of 207 older
people (>75 years) with AF and first ever ischaemic stroke. During the
follow-up period (mean 88.4 months, range 3-120), the study population
was under either oral anticoagulants (n = 72) or aspirin (n = 135).
Death and recurrent vascular events (stroke and systemic embolism) were
documented. Statistical analyses were performed by means of the
Kaplan-Meier product limit method and the Cox proportional hazards
model.
Results: the cumulative 10 year mortality and recurrence rate were
92.5% (95% CI 85.7-99.3) and 66.1% (95% CI 43.1-89.1), respectively.
Cox regression analysis revealed increasing age, functional dependency
at hospital discharge and antiplatelet versus anticoagulation therapy as
independent determinants of mortality. Antiplatelet versus
anticoagulation therapy was the sole determinant of vascular recurrence.
Anticoagulation was associated with decreased risk of death (hazards
ratio (HR) 0.47, 95% CI 0.31-0.72, P = 0.001)) and recurrent
thromboembolism (HR 0.31, 95% CI 0.16-0.62, P = 0.002).
Conclusions: our results suggest that the benefits of anticoagulation
for secondary stroke prevention in AF patients extend to the oldest old.
Prospective randomised clinical trials are needed to verify the
potential benefit of anticoagulation in such patients