{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T12:30:06Z","timestamp":1787056206468,"version":"build-2736575974"},"reference-count":28,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,31]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine oral anticoagulant (OAC) prescription patterns and clinical outcomes, among elderly patients with atrial fibrillation (AF) during the era of widespread direct oral anticoagulant (DOAC) use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study used nationwide electronic health records from multiple centres across Israel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients with incident AF aged \u226575 years who were diagnosed between 1 January 2010 and 1 January 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Incidence of stroke, intracranial haemorrhage (ICH) and gastrointestinal bleeding (GIB) were estimated as the number of events per 100 person-years. Inverse probability weighting was used to estimate adjusted risk ratios for stroke, ICH, GIB and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>45\u2009820 patients were included. The median age was 83 (IQR, 79\u201383), including 26\u2009590 females (58%); 15\u2009019 received DOAC, 7114 used warfarin and 23\u2009687 were OAC non-users. Overall initial OAC prescription rates increased from 31% in 2010 (100% warfarin) to 66% (98% DOAC) in 2019. Compared with OAC non-users, DOAC-treated patients had decreased risk of stroke (adjusted risk ratio (aRR) 0.71, 95% CI 0.64 to 0.79)\u2009and GIB (aRR 0.81, CI 0.74 to 0.90), but similar ICH risk (aRR 0.98, CI 0.84 to 1.16). Warfarin-treated patients had similar risk of stroke (aRR 1.1, CI 0.99 to 1.24), increased risk of ICH (aRR 1.32, CI 1.10 to 1.57) and GIB (aRR 1.13, CI 1.02 to 1.26). Both DOAC (aRR 0.83, CI 0.81 to 0.85)\u2009and warfarin (aRR 0.93, CI 0.90 to 0.95) groups had lower mortality risk than OAC non-users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among elderly patients with AF, DOAC use increased over time and was associated with favourable clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-121683","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T11:50:34Z","timestamp":1787053834000},"page":"e121683","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Direct oral anticoagulants in elderly patients with atrial fibrillation: a decade-long nationwide retrospective cohort study"],"prefix":"10.1136","volume":"16","author":[{"given":"Hilmi","family":"Alnsasra","sequence":"first","affiliation":[{"name":"Cardiology Department, Soroka University Medical Center, Beersheva, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gal","family":"Tsaban","sequence":"additional","affiliation":[{"name":"Cardiology Department, Soroka University Medical Center, Beersheva, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ostrovsky","sequence":"additional","affiliation":[{"name":"Cardiology Department, Soroka University Medical Center, Beersheva, Israel"},{"name":"Clinical Research Center, Soroka University Medical Center, Beersheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa","family":"Livne","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7764-7034","authenticated-orcid":false,"given":"Blake","family":"Filderman","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaakov","family":"Henkin","sequence":"additional","affiliation":[{"name":"Cardiology Department, Soroka University Medical Center, Beersheva, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3324-4883","authenticated-orcid":false,"given":"Zaza","family":"Iakobishvili","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel"},{"name":"Community Cardiology, Central District, Clalit Health Services, Tel-Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Arnson","sequence":"additional","affiliation":[{"name":"Meir Medical Center, Kfar Saba, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Eisen","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel"},{"name":"Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiska","family":"Weisband","sequence":"additional","affiliation":[{"name":"Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Schliamser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Carmel Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moti","family":"Haim","sequence":"additional","affiliation":[{"name":"Cardiology Department, Soroka University Medical Center, Beersheva, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"2026081804501805000_16.8.e121683.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi825"},{"key":"2026081804501805000_16.8.e121683.2","doi-asserted-by":"crossref","unstructured":"Haim M , Hoshen M , Reges O , et al . 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