Stroke Prevention With Oral Anticoagulants in High-Risk Atrial Fibrillation in an Aging Population

Aging societies will pose unique health challenges in the near future. Elderly and very elderly patients often have complex medical needs, including comorbidities and polypharmacy. Contributing to this, atrial fibrillation (AF) is common among elderly patients. Direct oral anticoagulants are widely used to prevent stroke in patients with AF. However, patients in randomized controlled trials tend to be younger than many patients with AF and may not have the complicating factors that can influence treatment decisions. In this review, we summarize what is currently known about direct oral anticoagulants in elderly (age 65-79 years) and very elderly (age ≥80 years) patients with AF, and highlight the remaining gaps in the literature. Although further randomized controlled trials are needed, the ELDERCARE-AF (Edoxaban Low-Dose for Elder Care Atrial Fibrillation Patients) trial may have contributed to filling these gaps.