Bleeding Risk Tied to Higher Mortality in Older Adults With Atrial Fibrillation Taking Anticoagulants

About 20% of older adults have atrial fibrillation. Oral anticoagulant therapy is recommended to prevent stroke and thromboembolism in this population, but it can increase the risk of bleeding. Understanding this risk-benefit balance is essential to help clinicians develop appropriate care plans. To explore real-world outcomes, researchers conducted a study assessing the impact of bleeding and stroke on mortality in older adults with atrial fibrillation.

The study, published in Drugs & Aging, was a retrospective analysis conducted across three acute geriatric facilities in Italy between 2014 and 2018. Researchers included patients aged 75 years and older with atrial fibrillation who were prescribed oral anticoagulants at the time of hospital discharge. Baseline frailty status was recorded, and patients were followed up for 1 year. Investigators tracked survival and the occurrence of ischemic stroke (IS) and major or clinically relevant nonmajor bleeding (MB/CRNMB) using a centralized database. Associations with 1-year mortality were assessed using a multivariable Cox regression model, treating IS and MB/CRNMB as time-dependent variables.

The cohort included 1,684 patients with a median age of 86 years. Most were classified as frail (67.2%) or prefrail (24.2%). Within 1 year, 36.2% of patients had died. Bleeding events occurred in 4.7% of patients, and IS, in 2.9%. Those who experienced bleeding had a nearly fourfold increased risk for death (hazard ratio [HR],  3.82; 95% CI, 2.68-5.45), and patients who had a stroke faced nearly twice the risk (HR, 1.82; 95% CI, 1.14-2.90).

The findings highlight the clinical complexity of anticoagulation management in this high-risk population. The authors concluded that balancing stroke prevention and bleeding risk remains a major challenge and called for larger prospective studies to confirm these findings.