PMID- 19182090
OWN - NLM
STAT- MEDLINE
DCOM- 20090424
LR  - 20230815
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 40
IP  - 4
DP  - 2009 Apr
TI  - Effect of age on stroke prevention therapy in patients with atrial fibrillation: 
      the atrial fibrillation investigators.
PG  - 1410-6
LID - 10.1161/STROKEAHA.108.526988 [doi]
AB  - BACKGROUND AND PURPOSE: Stroke risk increases with age in patients who have 
      nonvalvular atrial fibrillation. It is uncertain whether the efficacy of stroke 
      prevention therapies in atrial fibrillation changes as patients age. The 
      objective of this study was to determine the effect of age on the relative 
      efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including 
      acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and 
      vascular events in patients with atrial fibrillation. METHODS: This is an 
      analysis of the Atrial Fibrillation Investigators database, which contains 
      patient level-data from randomized trials of stroke prevention in atrial 
      fibrillation. We used Cox regression models with age as a continuous variable 
      that controlled for sex, year of randomization, and history of cerebrovascular 
      disease, diabetes, hypertension, and congestive heart failure. Outcomes included 
      ischemic stroke, serious bleeding (intracranial hemorrhage or systemic bleeding 
      requiring hospitalization, transfusion, or surgery), and cardiovascular events 
      (ischemic stroke, myocardial infarction, systemic embolism, or vascular death). 
      RESULTS: The analysis included 8932 patients and 17 685 years of observation from 
      12 trials. Patient age increased risk of ischemic stroke (adjusted hazard ratio 
      per decade increase 1.45; 95% CI, 1.26 to 1.66), serious bleeding (1.61; 1.47 to 
      1.77), and cardiovascular events (1.43; 1.33 to 1.53). Compared with placebo, OAC 
      and AP significantly reduced the risk of ischemic stroke (OAC, 0.36; 0.29 to 
      0.45; AP, 0.81; 0.72 to 0.90) and cardiovascular outcomes (OAC, 0.59; 0.52 to 
      0.66; AP, 0.81; 0.75 to 0.88), whereas OAC increased risk of serious bleeding 
      (1.56; 1.03 to 2.37). The relative benefit of OAC versus placebo or AP did not 
      vary by patient age for any outcome. Compared with placebo, the relative benefit 
      of AP for preventing ischemic stroke decreased significantly as patients aged 
      (P=0.01). CONCLUSIONS: As patients with atrial fibrillation age, the relative 
      efficacy of AP to prevent ischemic stroke appears to decrease, whereas it does 
      not change for OAC. Because stroke risk increases with age, the absolute benefit 
      of OAC increases as patients get older.
FAU - van Walraven, Carl
AU  - van Walraven C
AD  - University of Ottawa and Ottawa Health Research Institute Canada, Ottawa, Canada. 
      carlv@ohri.ca
FAU - Hart, Robert G
AU  - Hart RG
FAU - Connolly, Stuart
AU  - Connolly S
FAU - Austin, Peter C
AU  - Austin PC
FAU - Mant, Jonathan
AU  - Mant J
FAU - Hobbs, F D Richard
AU  - Hobbs FD
FAU - Koudstaal, Peter J
AU  - Koudstaal PJ
FAU - Petersen, Palle
AU  - Petersen P
FAU - Perez-Gomez, Francisco
AU  - Perez-Gomez F
FAU - Knottnerus, J Andre
AU  - Knottnerus JA
FAU - Boode, Beppie
AU  - Boode B
FAU - Ezekowitz, Michael D
AU  - Ezekowitz MD
FAU - Singer, Daniel E
AU  - Singer DE
LA  - eng
GR  - G9900264/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20090129
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
CIN - Ann Intern Med. 2009 Jul 21;151(2):JC1-4. PMID: 19620148
CIN - Evid Based Med. 2009 Oct;14(5):140. PMID: 19794015
CIN - Praxis (Bern 1994). 2010 Mar 31;99(7):449-50. PMID: 20358521
MH  - Age Distribution
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/therapeutic use
MH  - Atrial Fibrillation/*epidemiology
MH  - Brain Ischemia/epidemiology/prevention & control
MH  - Cerebral Hemorrhage/epidemiology/prevention & control
MH  - Databases, Factual
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Multivariate Analysis
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - Stroke/*epidemiology/*prevention & control
MH  - Thrombosis/drug therapy/*epidemiology/*prevention & control
EDAT- 2009/02/03 09:00
MHDA- 2009/04/25 09:00
CRDT- 2009/02/03 09:00
PHST- 2009/02/03 09:00 [entrez]
PHST- 2009/02/03 09:00 [pubmed]
PHST- 2009/04/25 09:00 [medline]
AID - STROKEAHA.108.526988 [pii]
AID - 10.1161/STROKEAHA.108.526988 [doi]
PST - ppublish
SO  - Stroke. 2009 Apr;40(4):1410-6. doi: 10.1161/STROKEAHA.108.526988. Epub 2009 Jan 
      29.