{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:24:48Z","timestamp":1790112288528,"version":"4.0.1"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Increasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1\u2010year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age \u226585\u00a0years) compared with younger patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We accessed individual patients\u2019 data from the prospective PREFER in AF (PREvention oF thromboembolic events\u2010European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (\n              <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>\n              ), and estimated weighed net clinical benefit in different age groups. A total of 6412 patients, 505 of whom were aged \u226585\u00a0years, were analyzed. In patients aged &lt;85\u00a0years, the incidence of thromboembolic events was 2.8%\/year without\n              <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>\n              versus 2.3%\/year with\n              <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>\n              (0.5% absolute reduction); in patients aged \u226585\u00a0years, it was 6.3%\/year versus 4.3%\/year (2% absolute reduction). In very elderly patients, the risk of major bleeding was higher than in younger patients, but similar in patients on\n              <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>\n              and in those on antiplatelet therapy or without antithrombotic treatment (4.0%\/year versus 4.2%\/year;\n              <jats:italic>P<\/jats:italic>\n              =0.77).\n              <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>\n              was overall associated with weighted net clinical benefit, assigning weights to nonfatal events according to their prognostic implication for subsequent death (\u22122.19%;\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u22124.23%, \u22120.15%;\n              <jats:italic>P<\/jats:italic>\n              =0.036). We found a significant gradient of this benefit as a function of age, with the oldest patients deriving the highest benefit.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of\n              <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>\n              is highest in very elderly patients, where it, by far, outweighs the risk of bleeding, with the greatest net clinical benefit in such patients.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.005657","type":"journal-article","created":{"date-parts":[[2017,7,24]],"date-time":"2017-07-24T00:10:16Z","timestamp":1500855016000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":145,"title":["Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub\u2010Analysis From the PREFER in AF (\n            <i>PRE<\/i>\n            vention o\n            <i>F<\/i>\n            Thromboembolic Events\u2013\n            <i>E<\/i>\n            uropean\n            <i>R<\/i>\n            egistry in\n            <i>A<\/i>\n            trial\n            <i>F<\/i>\n            ibrillation)"],"prefix":"10.1161","volume":"6","author":[{"given":"Giuseppe","family":"Patti","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, Campus Bio\u2010Medico University of Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Lucerna","sequence":"additional","affiliation":[{"name":"Daiichi Sankyo Europe, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladislav","family":"Pecen","sequence":"additional","affiliation":[{"name":"Institute of Informatics, Academy of Sciences of Czech Republic, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta M.","family":"Siller\u2010Matula","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Cavallari","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Campus Bio\u2010Medico University of Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulus","family":"Kirchhof","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom"},{"name":"SWBH and UHB NHS Trust, Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"De Caterina","sequence":"additional","affiliation":[{"name":"G. d'Annunzio University of Chieti and Center of Excellence on Aging CeSI\u2010Met, Chieti, Italy"},{"name":"Fondazione G. Monasterio, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","volume-title":"National Population Projections 2010\u2010Based Statistical Bulletin","year":"2011","unstructured":"National Population Projections 2010\u2010Based Statistical Bulletin. London: Office for National Statistics; 2011. Available at: http:\/\/www.ons.gov.uk\/ons\/dcp171778_235886.pdf. Accessed November 1, 2016."},{"key":"e_1_3_4_3_2","first-page":"3238","article-title":"Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis","volume":"36","author":"Andreotti F","year":"2015","unstructured":"Andreotti F, Rocca B, Husted S, Ajjan RA, ten Berg J, Cattaneo M, Collet JP, De Caterina R, Fox KAA, Halvorsen S, Huber K, Hylek EM, Lip GYH, Montalescot G, Morais J, Patrono C, Verheugt FWA, Wallentin L, Weiss TW, Storey RF; on behalf of the ESC Thrombosis Working Group . 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