P2246Effectiveness and safety of oral anticoagulants in patients aged 90 years or older with atrial fibrillation

The ageing heart: a target for interventions and aggressive pharmacotherapy 441 (MACE) defined as the composite of cardiovascular death, myocardial infarction and stroke was analyzed.Results: Clinically relevant bleedings (Bleeding Academic Research Consortium types 2, 3 or 5) were frequently observed (20.6%, n=181 patients) with one third of bleeding events occurring in the first month.Cutaneous and gastro-intestinal bleedings were the two predominant complications.There was no difference according to the P2Y12 inhibitor used between patients with a bleeding complication (prasugrel 5mg: 77.3%, prasugrel 10mg: 2.8% and clopidogrel 75mg: 19.9%) and those without (prasugrel 5mg: 77.9%, prasugrel 10mg: 2.5%, clopidogrel 75mg: 19.6%) (p=0.91).MACE occurred more frequently at one year in patients with a bleeding complication (16.6% vs 7.6%, adj.HR 2.04 (1.24; 3.38); p=0.005).Rates of myocardial infarction (Fig. 1A) and particularly stroke (Fig. 1B) were higher at one year after bleeding complications (9.9% vs 4.5%, adj.HR (95% CI): 2.40 (1.24; 4.66); p=0.0093 and 6.6% vs 1%, adj.HR (95% CI): 5.55 (2.04; 15.06); p=0.0008 respectively) without significant difference in death (6.6% vs 4.0%; HR (95% CI): 1.20 (0.57; 2.51); p=0.63).Predictive factors of major bleedings in the multivariate model were age >85 years [adj.HR (95% CI): 2.48 (1.25; 4.91); p=0.0093] and hemoglobin level (per gram of decrease) [adj.HR (95% CI): 1.45 (1.18; 1.79); p=0.0004].Conclusions: Clinically relevant bleedings were frequently observed in elderly patients and strongly associated with myocardial infarction and stroke.Age itself remained a predictive factor of bleeding in this population over the age of 75 years.