Anticoagulation for Atrial Fibrillation in Frail and Cognitively Impaired Older Adults

Assessing tradeoffs between stroke prevention and bleeding can be particularly challenging in older adults with atrial fibrillation (AF). Two new U.S. observational studies address benefits and risks of anticoagulation in older patients with frailty, cognitive impairment, and dementia.

In one study, 1200 older adults with AF (mean age, 75; mean CHA2DS2VASc score, 4.4) were followed for 2 years. Anticoagulation was associated with excess major bleeding or death in cognitively impaired patients (hazard ratio, 2.23), but not in cognitively intact patients (HR, 0.94). Among cognitively impaired patients, the number needed to harm with use of anticoagulation was 8, whereas the number needed to treat for stroke prevention was 30. Harms associated …