Prescribing patterns of antithrombotic drugs to elderly patients with atrial fibrillation admitted to an acute geriatric unit

Background and aims: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a prevalence up to >10% in people aged 75+. It is associated with an increased mortality risk, especially after ischemic stroke. Despite international guidelines strongly recommend the use of oral anticoagulant (OAC) they are still underused, especially among the elderly. Aims of this study are to evaluate the antithrombotic regimen at admission and to assess the factors predicting the prescribing patterns prior to hospitalization. Materials and methods: Retrospective observational study conducted at an Italian acute geriatric unit over a period of 17 months. Inclusion criteria were age >65 years and diagnosis of AF. Patients were divided into four groups according to their use of OAC, APT, LWHM or no antithrombotic treatment and a multivariate analysis were performed. Results: Among 399 patients with AF only 198(49.6%) were assigned to OAC, 125 (31.3%) to APT, 32 (8%) to LWMH and 44 (11%) to none of them. In multivariate analysis regression models, age ≥90 years, history of CHF and having >2 comorbidities were independent predictors of APT use rather than OAC. Being malnourished and having >2 comorbidities were independent predictors of LWMH use, while living in nursing home and taking >5 drugs predicted both LWMH and no antithrombotic use. Conclusions: Our data confirmed that about half of the geriatric patients with AF in this population did not received any OAC therapy before admission. We found that factors that might influence decisions of antithrombotic treatment were both medical and social.