Anticoagulant Therapy in Older Stroke Survivors With Atrial Fibrillation

Researchers sought to determine long-term outcomes related to anticoagulant use in older patients with history of stroke.

Among stroke survivors with atrial fibrillation (AF) who are at least 90 years of age, anticoagulant therapy may be validated for preventing secondary stroke, according to study findings published recently in the Journal of Clinical Neuroscience.

Researchers sought to investigate long-term anticoagulant therapy benefits among the oldest of stroke survivors with AF. To accomplish this, they conducted a retrospective study from a follow-up registry in Japan of 1484 patients admitted for ischemic stroke or transient ischemic stroke between 2014 through 2018.

Of these patients, 172 were at least 90 years of age, and 90 of them were diagnosed with AF. Of these patients, 77 survived hospitalization and 71 (aged median 93 years [range, 90-105]; 73% women) were discharged on anticoagulants. Thirty-nine of these patients were treated with a direct oral anticoagulant (DOAC) (aged median 92 years [range, 90-99]; 69% women) and 32 were treated with warfarin (aged median 93 years [range, 90-105]; 78% women). The primary outcome was stroke and death following discharge.

In the follow-up period (median 466 days), 13% of the patients had another stroke (100% ischemic with no fatal bleeding) and 35% of the patients died. The incidence of recurrent stroke was consistent between anticoagulants (DOAC 15%/year, warfarin 13%/year, P =.743). A significantly greater proportion of patients died on warfarin (47%) vs DOAC (21%), however researchers pointed out the variance in severity of stroke and the prevalence of DOAC prescribed in mild cases.

Study limitations include that the sample size was underpowered and from a single medical center. The follow-up time was too brief to detect hemorrhagic stroke and the follow-up identification of minor bleeding events by phone call or letters may have missed a few such events.

“Given that a higher proportion of oldest-old stroke survivors with AF on anticoagulant therapy have recurrent ischemic stroke rather than hemorrhagic stroke, long-term anticoagulant therapy may be justified for secondary stroke prevention,” the study authors wrote.

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Hamanaka M, Tanaka E, Yamada T, Kishitani T, Fujinami J, Nagakane Y. Long-term effectiveness of anticoagulants in oldest-old stroke survivors with atrial fibrillation. J Clin Neurosci. Published online June 7, 2022. doi:10.1016/j.jocn.2022.05.029