Efficacy and safety of different intensities of anticoagulation with warfarin in elderly patients with non-valvular atrial fibrillation

Abstract

Objective: To evaluate the efficacy and safety of different intensities of warfarin anticoagulant therapy in elderly patients with non-valvular atrial fibrillation (NVAF).

Methodology: This retrospective study was conducted at Chun’an First People’s Hospital. Clinical records of 108 elderly patients with NVAF who received warfarin anticoagulant therapy from January 2022 to August 2023 were included. Among them, 54 patients were assigned to the low-intensity anticoagulation group (international normalized ratio [INR]: 1.6-2.0), and 54 patients comprised the standard-intensity anticoagulation group (INR: 2.1-3.0). All patients were followed up for 24 months. The creatinine clearance (Ccr) before treatment and at 3, 6, 12, and 24 months after treatment was assessed. Incidents of thromboembolism and bleeding in the two groups during the follow-up period were compared.

Results: There were no statistically significant differences in the Ccr levels between the two groups before treatment and at each time point after treatment (P>0.05).​ No statistically significant differences were observed between the two groups in terms of the incidences of ischemic stroke, systemic embolism, non-fatal myocardial infarction, and all-cause mortality (P>0.05).​ The total incidence of bleeding events in the low-intensity group was lower than that in the standard-intensity group (P<0.05).

Conclusions: The results of this study indicate that low-intensity warfarin anticoagulation has similar renal function outcomes (as assessed by creatinine clearance) to standard-intensity anticoagulation, with no increase in the risk of thromboembolism. However, low-intensity anticoagulation is associated with a lower risk of bleeding.