0203: Analysis of antithrombotic therapy in patients over 75 years with non-valvular atrial fibrillation: do we apply the guidelines to elderly subjects?

Introduction and Objectives Atrial fibrillation (AF) is associated with a five times higher risk of stroke mortality. The benefit of anticoagulants in this context is widely recognized, particularly for older patients. Past studies show reluctance to anticoagulate seniors because of their bleeding risk. The European guidelines are regularly updated to promote the prescription of anticoagulants in this population. The purpose of this study is to evaluate the type and rate of antithrombotic prescription in real life in patients over 75 years with a history of non-valvular AF. Methods This is a retrospective study performed in Nimes University Hospital and Beziers Hospital. We studied 293 consecutive outpatients who consulted their cardiologist between April and November 2012. The following data were analyzed: CHA 2 DS 2 VASc score, HAS-BLED score, antithrombotic therapy, type of AF, demographics. Results The mean age of patients is 82 years (+/-5.1 years, 75-99 years). 219 patients (74.7%) receive oral anticoagulants: 60.4% are treated with vitamin K antagonists (VKA) and 14.3% with novel oral anticoagulants (NOACs). 60 patients (20.6%) get aspirin or clopidogrel alone or in various combinations, 14 patients (4.7%) receive no antithrombotic treatment. The rate of anticoagulation (VKA or NOACs) decrease moderately with age: 81.5% (75-79 years), 75% (80-84 years) and 67% after 85 years. It is more important in case of permanent AF (83%) versus paroxysmal (67%). Women are less anticoagulated (67%) than men (82%). Conclusions A higher rate of anticoagulation is found in this elderly population compared with previous “real life” records. Anticoagulant therapy is however less systematic in paroxysmal AF and women.