Temporal Trends in Oral Anticoagulant Use and Clinical Outcomes Among Older Adults with Atrial Fibrillation: Insights from a Danish Nationwide Study and Contemporary Evidence

Highlights

• The Danish nationwide study from 1999 to 2022 demonstrated increased uptake of oral anticoagulants (OACs) in older adults with atrial fibrillation (AF), with a significant reduction in stroke incidence across age groups.
• Direct oral anticoagulants (DOACs) have improved stroke prevention efficacy and safety profiles compared to vitamin K antagonists (VKAs), especially in elderly and high-risk populations.
• In very elderly patients (≥85 years), stroke risk reduction was modest and accompanied by increased intracerebral hemorrhage (ICH) risk, underscoring the need for individualized treatment.
• Adherence to anticoagulation and dynamic risk assessment, including bleeding risk monitoring (e.g., HAS-BLED score), are vital to optimize outcomes in elderly AF patients.

Background