Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-AB26 - Refining Stroke Prevention in Atrial Fibrillation (ID 13) Abstract

D-AB26-01 - Effectiveness And Safety Of Anticoagulation Therapy In Frail Patients With Atrial Fibrillation: A Propensity-weighted Cohort Study (ID 1462)


Background: Frail patients with AF are less likely to be anticoagulated despite frailty being associated with poorer outcomes including stroke.
Objective: To assess the effectiveness and safety of oral anticoagulants (OACs) in frail AF patients.
Methods: We enrolled 103,781 frail adults with non-valvular AF from the Korean national health insurance service database (2013-2016). Frailty was identified using the Hospital Frailty Risk score (≥5), which was calculated based on 109 diagnostic codes. Inverse probability of treatment-weighting was used to compare the risks of ischemic stroke, major bleeding, cardiovascular death, and the composite endpoint between untreated and OAC-treated patients, and between direct oral anticoagulants (DOAC) and warfarin users.
Results: In the study population (53.2% women; mean age: 73.8 years), 23,049 composite events occurred during a mean follow-up of 15.3 months. In propensity-weighted competing risk regressions (all-cause death as a competing event), relative to untreated patients, OAC users were at lower risks for ischemic stroke (HR 0.90, 95% CI 0.86-0.95), cardiovascular death, and composite endpoint with no significant difference observed for major bleeding (HR 0.98, 95% CI 0.94-1.02). When comparing DOAC with warfarin, DOAC use was associated with reduced risks of ischemic stroke (HR 0.74, 95% CI 0.69-0.80), major bleeding (HR 0.72, 95% CI 0.67-0.79), cardiovascular death, and composite endpoint.
Conclusion: In this propensity-weighted analysis using a real-world AF population with frailty, OAC use was associated with favorable outcomes without increasing bleeding risk. DOACs showed better effectiveness and safety than warfarin.