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Net Clinical Benefit of Oral Anticoagulation Among Frail Patients With Atrial Fibrillation: Nationwide Cohort Study.
Søgaard et al., Stroke 2024
DOI: 10.1161/STROKEAHA.123.044407
New Insights:
This study provides new evidence on the net clinical benefit (NCB) of oral anticoagulants (OACs) in frail patients with atrial fibrillation, a group that is often undertreated. It highlights the trade-off between the reduced risk of thromboembolic events and the increased risk of major bleeding associated with OAC treatment in this population.
Importance:
The findings are important as they offer a clearer understanding of the risks and benefits of OAC therapy in frail individuals, which can inform clinical decision-making and potentially improve patient outcomes.
Contribution to Literature:
The study contributes to the literature by quantifying the one-year risks of thromboembolic events and major bleeding in frail patients with atrial fibrillation, and by evaluating the NCB of OAC treatment in this specific group.
Results Summary:
- Out of 36,223 frail patients with atrial fibrillation, 61.8% received OAC therapy, while 38.2% did not, despite having an indication for stroke prevention.
- One-year risk of thromboembolic events was lower in patients on OAC (1.5%) compared to those not on OAC (2.1%).
- Major bleeding risk was slightly higher in patients on OAC (3.5%) compared to those not on OAC (3.2%).
- The NCB of OAC treatment was positive (0.70%) but decreased with age and increasing frailty, particularly in patients over 75 years or with a high level of frailty.