{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T14:31:50Z","timestamp":1782397910674,"version":"3.54.5"},"reference-count":35,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Background\/Objectives: Non-valvular atrial fibrillation (NVAF) is a common arrhythmia in the elderly and carries a high risk of cardioembolic stroke. Oral anticoagulation is central to prevention, with direct oral anticoagulants (DOACs) increasingly replacing warfarin due to better safety and convenience. However, major bleeding remains a key concern, particularly in older patients. This study aimed to determine the prevalence of major bleeding among elderly patients (\u226565 years) with NVAF treated with oral anticoagulants. Methods: A retrospective cohort study was conducted on 886 elderly NVAF patients managed at a tertiary hospital between January 2012 and December 2023. Data on demographics, anticoagulant type, comorbidities, and bleeding events were collected. Associations between categorical variables were tested using Chi-square or Fisher\u2019s exact tests, while logistic regression identified predictors of major bleeding. Results: The mean age was 78.4 \u00b1 7.2 years, with equal gender distribution. Most patients (87.1%) received DOACs, while 12.9% were prescribed warfarin. A total of 63 patients (7.1%) experienced major bleeding, including 51 (6.6%) in the DOAC group and 12 (10.5%) in the warfarin group. Intracranial and intra-\/retroperitoneal hemorrhages were most common. Logistic regression showed older age, prior bleeding, a higher HASBLED score, and antiplatelet use as significant predictors. Among patients with a recorded weight (n = 70), dosing adherence was better for apixaban and edoxaban compared to dabigatran and rivaroxaban. Conclusions: DOACs were associated with fewer major bleeding events than warfarin. Bleeding risk was strongly linked to age, prior bleeding, HASBLED score, and concomitant antiplatelet therapy, highlighting the importance of appropriate DOAC dosing for safety.<\/jats:p>","DOI":"10.3390\/geriatrics10060165","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T09:36:39Z","timestamp":1765791399000},"page":"165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of Major Bleeding in Elderly Patients on Oral Anticoagulants for Non-Valvular Atrial Fibrillation: A Single-Center 12-Year Retrospective Review"],"prefix":"10.3390","volume":"10","author":[{"given":"How Foong","family":"Kwan","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8226-9550","authenticated-orcid":false,"given":"Hazlina","family":"Mahadzir","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6124-8120","authenticated-orcid":false,"given":"Nor Rafeah","family":"Tumian","sequence":"additional","affiliation":[{"name":"Department of Haematology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8050-4150","authenticated-orcid":false,"given":"Azimatun Noor","family":"Aizuddin","sequence":"additional","affiliation":[{"name":"Department of Secretariat of Postgraduate Studies, University Kebangsaan Malaysia, Kuala Lumpur 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1156-1620","authenticated-orcid":false,"given":"Shue Hong","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","unstructured":"Nesheiwat, Z., Goyal, A., and Jagtap, M. (2025). Atrial Fibrillation. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_2","unstructured":"National Institute for Health and Care Excellence (NICE) (2022). Atrial Fibrillation: Diagnosis and Management, National Institute for Health and Care Excellence (NICE). NICE Guideline, No. 196."},{"key":"ref_3","first-page":"e1","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation","volume":"149","author":"Joglar","year":"2023","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S0140-6736(14)61774-8","article-title":"50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: A cohort study","volume":"386","author":"Schnabel","year":"2015","journal-title":"Lancet"},{"key":"ref_5","first-page":"789","article-title":"Stroke prevention in atrial fibrillation: An Asian perspective","volume":"111","author":"Chiang","year":"2014","journal-title":"Thromb. Haemost."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1136\/heartasia-2016-010775","article-title":"Prevalence of atrial fibrillation in the Malaysian communities","volume":"8","author":"Lim","year":"2016","journal-title":"Heart Asia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1161\/CIR.0b013e31820a55f5","article-title":"Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association","volume":"123","author":"Heidenreich","year":"2011","journal-title":"Circulation"},{"key":"ref_8","unstructured":"Aziz, Z.A., and Sidek, N.N. (2017). Annual Report of the Malaysian Stroke Registry 2009\u20132016, National Stroke Registry Malaysia. Stroke Registry Report 2009\u20132016."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"826.e13","DOI":"10.1016\/j.amjmed.2011.11.024","article-title":"Vascular disease and stroke risk in atrial fibrillation: A nationwide cohort study","volume":"125","author":"Olesen","year":"2012","journal-title":"Am. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1093\/eurheartj\/ehr488","article-title":"Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182,678 patients with atrial fibrillation: The Swedish Atrial Fibrillation cohort study","volume":"33","author":"Friberg","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1161\/STROKEAHA.109.549428","article-title":"Effect of age on stroke prevention therapy in patients with atrial fibrillation","volume":"40","author":"Hart","year":"2009","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest"},{"key":"ref_13","first-page":"1461","article-title":"Validation of the HAS-BLED tool in atrial fibrillation patients receiving rivaroxaban","volume":"9","author":"Gorman","year":"2016","journal-title":"J. Atr. Fibrillation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/ehjqcco\/qcab025","article-title":"Two-year outcomes of more than 30,000 elderly patients with atrial fibrillation: Results from the All Nippon AF In the Elderly (ANAFIE) Registry","volume":"8","author":"Yamashita","year":"2022","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1056\/NEJMoa0905561","article-title":"Dabigatran versus warfarin in patients with atrial fibrillation","volume":"361","author":"Connolly","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1093\/ehjcvp\/pvy044","article-title":"Comparative safety and effectiveness of dabigatran vs rivaroxaban and apixaban in patients with non-valvular atrial fibrillation: A retrospective study from a large healthcare system","volume":"5","author":"Villines","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"115","DOI":"10.15420\/aer.2013.2.2.115","article-title":"The European Heart Rhythm Association Practical Guide on the Use of New Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation\u2014A Brief Summary","volume":"2","author":"Mountfort","year":"2013","journal-title":"Arrhythm. Electrophysiol. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s40268-019-0275-y","article-title":"Elderly bleeding risk of direct oral anticoagulants in nonvalvular atrial fibrillation: A systematic review and meta-analysis of cohort studies","volume":"19","author":"Baksh","year":"2019","journal-title":"Drugs R&D"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lan, Y., Chen, J., Niu, P., Huang, X., Dong, X., You, C., Jiang, S., and Zhang, J. (2025). Efficacy, safety, and bleeding risk factor analysis of oral anticoagulants in AF patients \u226565 years of age: A multicenter retrospective cohort study. BMC Geriatr., 25.","DOI":"10.1186\/s12877-025-05838-4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1253\/circj.CJ-16-1337","article-title":"Current status and outcomes of direct oral anticoagulant use in real-world atrial fibrillation patients\u2015Fushimi AF Registry","volume":"81","author":"Yamashita","year":"2017","journal-title":"Circ. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"39233","DOI":"10.31083\/RCM39233","article-title":"Anticoagulation for stroke prevention in patients with atrial fibrillation: A review of the literature and current guidelines","volume":"26","author":"Vyas","year":"2025","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","article-title":"Edoxaban versus warfarin in patients with atrial fibrillation","volume":"369","author":"Giugliano","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1093\/ehjcvp\/pvac063","article-title":"Head-to-head efficacy and safety of rivaroxaban, apixaban, and dabigatran in an observational nationwide targeted trial","volume":"9","author":"Yacovzada","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1002\/cpt.3654","article-title":"Impact of age and factor Xa inhibitor concentrations on bleeding risk in patients with atrial fibrillation","volume":"118","author":"Lin","year":"2025","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Jeong, J., Heo, K.N., Lee, S., Ah, Y.-M., Min, S., Han, J.M., and Lee, J.-Y. (2024). Exploring bleeding in oral anticoagulant users: Assessing incidence by indications and risk factors in the entire nationwide cohort. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1399955"},{"key":"ref_26","first-page":"102285","article-title":"Risk scores for major bleeding from direct oral anticoagulants: Comparing predictive performance in patients with atrial fibrillation","volume":"7","author":"Jacoby","year":"2023","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ejim.2024.06.022","article-title":"Performance of HAS-BLED and DOAC scores to predict major bleeding events in atrial fibrillation patients treated with direct oral anticoagulants: A report from a prospective European observational registry","volume":"128","author":"Mei","year":"2024","journal-title":"Eur. J. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1111\/bcp.13265","article-title":"Risk of major bleeding and stroke associated with the use of vitamin K antagonists, non-vitamin K antagonist oral anticoagulants and aspirin in patients with atrial fibrillation: A cohort study","volume":"83","author":"Gieling","year":"2017","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"429","DOI":"10.3988\/jcn.2022.0289","article-title":"Stroke-Specific Predictors of Major Bleeding in Anticoagulated Patients With Stroke and Atrial Fibrillation: A Nationwide Multicenter Registry-Based Study","volume":"19","author":"Chung","year":"2023","journal-title":"J. Clin. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1111\/bcp.14227","article-title":"Risk of major bleeding among users of direct oral anticoagulants combined with interacting drugs: A population-based nested case-control study","volume":"86","author":"Zhang","year":"2020","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.thromres.2023.03.007","article-title":"Inappropriate prescriptions of direct oral anticoagulants (DOACs) in hospitalized patients: A narrative review","volume":"231","author":"Huisman","year":"2023","journal-title":"Thromb. Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Shen, N.N., Zhang, C., Hang, Y., Li, Z., Kong, L.-C., Wang, N., Wang, J.-L., and Gu, Z.-C. (2021). Real-world prevalence of direct oral anticoagulant off-label doses in atrial fibrillation: An epidemiological meta-analysis. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.581293"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1136\/heartjnl-2022-321114","article-title":"Outcomes and drivers of inappropriate dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: A systematic review and meta-analysis","volume":"109","author":"Caso","year":"2023","journal-title":"Heart"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/bcp.15017","article-title":"Determinants for under- and overdosing of direct oral anticoagulants and physicians\u2019 implementation of clinical pharmacists\u2019 recommendations","volume":"88","author":"Moudallel","year":"2022","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s10557-022-07409-w","article-title":"Prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation: The ANATOLIA-AF Study","volume":"38","author":"Ergin","year":"2024","journal-title":"Cardiovasc. Drugs Ther."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/10\/6\/165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:23:52Z","timestamp":1765794232000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/10\/6\/165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["geriatrics10060165"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics10060165","relation":{},"ISSN":["2308-3417"],"issn-type":[{"value":"2308-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]}}}