Anticoagulation for stroke prevention in atrial fibrillation (AF) has, historically, been under-used in older people. The aim of this study was to investigate prescribing of oral anticoagulants (OACs) for people aged ≥ 75 years in the UK before and after direct oral anticoagulants (DOACs) became available. A cohort of patients aged ≥ 75 years with a diagnosis of AF was derived from the Clinical Practice Research Datalink (CPRD) between January 1, 2003, and December 27, 2017. Patients were grouped as no OAC, incident OAC (OAC newly prescribed) or prevalent OAC (entered study on OAC). Incidence and point prevalence of OAC prescribing were calculated yearly. The risk of being prescribed an OAC if a co-morbidity was present was calculated; the risk difference (RD) was reported. Kaplan-Meier curves were used to explore persistence with anticoagulation. A Cox regression was used to model persistence with warfarin and DOACs over time. The cohort comprised 165,596 patients (66,859 no OAC; 47,916 incident OAC; 50,821 prevalent OAC). Incidence of OAC prescribing increased from 111 per 1000 person-years in 2003 to 587 per 1000 person-years in 2017. Older patients (≥ 90 years) were 40% less likely to receive an OAC (RD −0.40, 95% CI −0.41 to −0.39) than younger individuals (75–84 years). The likelihood of being prescribed an OAC was lower with a history of dementia (RD −0.34, 95% CI −0.35 to −0.33), falls (RD −0.17, 95% CI −0.18 to −0.16), major bleeds (RD −0.17, 95% CI −0.19 to −0.15) and fractures (RD −0.13, 95% CI −0.14 to −0.12). Persistence with warfarin was higher than DOACs in the first year (0–1 year: HR 1.25, 95% CI 1.17–1.33), but this trend reversed by the third year of therapy (HR 0.75, 95% CI 0.63–0.89). OAC prescribing for older people with AF has increased; however, substantial disparities persist with age and co-morbidities. Whilst OACs should not be withheld solely due to the risk of falls, these results do not reflect this national guidance. Furthermore, the under-prescribing of OACs for patients with dementia or advancing age may be due to decisions around risk-benefit management. EUPAS29923 . First registered on: 27/06/2019.

中文翻译：

---

英国全科医生为患有心房颤动的老年人开出直接口服抗凝剂和华法林的处方：一项队列研究

历史上，用于预防心房颤动（AF）卒中的抗凝治疗在老年人中并未得到充分利用。本研究的目的是调查直接口服抗凝剂 (DOAC) 上市之前和之后英国 75 岁以上人群的口服抗凝剂 (OAC) 处方情况。年龄≥75岁且诊断为房颤的患者队列源自2003年1月1日至2017年12月27日期间的临床实践研究数据链（CPRD）。患者被分为无OAC、偶发OAC（新开出的OAC）或流行的 OAC（已进入 OAC 研究）。每年计算 OAC 处方的发生率和点患病率。如果存在合并症，则计算开 OAC 处方的风险；报告了风险差异（RD）。Kaplan-Meier 曲线用于探索抗凝治疗的持久性。Cox 回归用于模拟华法林和 DOAC 随着时间的推移的持久性。该队列由 165,596 名患者组成（66,859 名无 OAC；47,916 名偶发性 OAC；50,821 名普​​遍性 OAC）。OAC 处方发生率从 2003 年的每 1000 人年 111 例增加到 2017 年的每 1000 人年 587 例。老年患者（≥ 90 岁）接受 OAC 的可能性降低 40%（RD -0.40，95% CI -0.41比年轻个体（75-84 岁）低至-0.39）。有痴呆病史（RD -0.34，95% CI -0.35 至 -0.33）、跌倒病史（RD -0.17，95% CI -0.18 至 -0.16）、大出血（RD - 0.17，95% CI -0.19 至 -0.15）和骨折（RD -0.13，95% CI -0.14 至 -0.12）。第一年华法林的持续性高于 DOAC（0-1 年：HR 1.25，95% CI 1.17-1.33），但这一趋势在治疗第三年逆转（HR 0.75，95% CI 0.63-0.89）。OAC 为患有 AF 的老年人开出的处方有所增加；然而，随着年龄和合并症的不同，仍然存在巨大差异。虽然 OAC 不应仅仅因为跌倒风险而被扣留，但这些结果并不反映这一国家指导。此外，对痴呆症或高龄患者的 OAC 处方不足可能是由于围绕风险收益管理的决策。EUPAS29923 。首次注册时间：2019年6月27日。