Oral anticoagulant therapy for older patients with atrial fibrillation

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. Its incidence and prevalence increase with age, representing a significant burden for health services in western countries. The most feared consequence of AF is cardio-embolic stroke, accounting for roughly one third of ischemic strokes in the elderly. Oral anticoagulant therapy is currently recommended for patients with AF and a CHA₂DS₂-VASc score ≥2 in men and ≥3 in women, but it is widely underused, particularly in the oldest patients who, in reason of their higher risk of stroke, might benefit more from it. Among the main reasons for anticoagulant underuse in older patients, advanced age itself, physician’s perceived high risk of age-related and fall-related bleedings, and difficulties in monitoring vitamin K antagonists-based therapies are the most frequently reported.