Stroke: Frail patients with atrial fibrillation, better prognosis with anticoagulation

People with a positive family history of aneurysmal subarachnoid hemorrhage (aSAH) are at increased risk of developing aSAH
.
Depending on the number of affected relatives, the lifetime risk of aSAH can be as high as 25%

When screening people with a positive family history of SAH, only 10% found IA at initial screening
.
Early risk stratification of people with IA may help identify people with high or low risk of IA, thereby increasing the efficiency of screening

In the general population, several prognostic factors increase the likelihood of IA, including older age, female sex, smoking, history of hypertension , history of indolent stroke and a positive family history of indolent stroke
.

This retrospective cohort study analyzed 83 635 patients with atrial fibrillation and frailty (hospital frailty risk score ≥5) at least 65 years of age in the Korean National Health Insurance Service database between January 1, 2013, and December 31, 2016
.

To account for differences between patients receiving or not receiving OAC and between different OAC regimens, propensity score weighting was used
.
Net adverse clinical events, defined as the first event of ischemic stroke, major bleeding, or cardiovascular death, were compared

In the study population (57.
1% women; mean age 78.
5±7.
2 years), there were 14 968 net adverse clinical events, 3718 ischemic strokes, 5536 major bleeding, and 6188 cardiovascular deaths
.

Compared with no OAC use, OAC use was associated with lower net adverse clinical events (hazard ratio, 0.
78 [95% CI, 0.
75-0.
82]), ischemic stroke (hazard ratio, 0.
91 [95% CI, 0.
86-0.
97] ]) and the risk of cardiovascular death (hazard ratio, 0.
52 [95% CI, 0.
49-0.
55]), but no difference was observed for major bleeding (hazard ratio, 1.
02 [95% CI, 0.
95-1.
10])
.

All four individual direct OACs were associated with a reduced risk of net adverse clinical events, ischemic stroke, major bleeding, and cardiovascular death compared with warfarin .

The association of OAC use (vs.
no OAC use) or direct OAC use (vs.

The significance of this study is its finding that in frail patients with AF, OAC treatment is associated with positive net clinical outcomes
.
Compared with warfarin, direct OACs provided lower rates of stroke, bleeding, and mortality

Original source:
Kim D, Yang PS, Sung JH, et al.
Effectiveness and Safety of Anticoagulation Therapy in Frail Patients With Atrial Fibrillation.
Stroke.
Published online February 3, 2022:STROKEAHA.