The impact of age on antithrombotic use in elderly patients with non-valvular atrial fibrillation

Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients >= 65 years, who were admitted to a Sydney teaching hospital over a 12-month period. Results: Overall, 202 (79%) patients were discharged on some antithrombotic therapy. Patients >= 80 years were as likely to receive antithrombotic therapy as those <80 years (75.8% versus 81.9%, P=0.23), but a significantly lower proportion received warfarin than did those <80 years (25.5% versus 61.5%, P<0.0001). Definite contraindications to anticoagulation were a significant influence on antithrombotic agent selection (P=0.04), but multivariate analysis indicated that 'old age' was the largest contributing factor: patients >= 80 years were 5.46 times more likely to receive aspirin in preference to warfarin than their younger counterparts (P<0.0001). Conclusion: Warfarin is being withheld in AF patients >= 80 years for reasons other than recognised contraindications and is, therefore, potentially underutilised in the target elderly population. Further studies are necessary to determine whether this is appropriate.