Aim: To evaluate the prevalence of oral anticoagulant (OAC) use in people aged ≥ 80 years with non-valvular atrial fibrillation (AF) and analyze factors that influence decisions to prescribe OACs, prescribe direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs), or withhold OACs in real world practice.
Methods: Electronic databases from 2013 to 2023 were searched to identify articles that evaluated OAC prescriptions and analyzed influencing factors in populations with a mean age ≥ 80 years. The quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) critical appraisal tool.
Results: Ten medium to high-quality studies were selected. The prevalence of OAC use varied widely, with an increasing trend towards DOAC prescriptions. Age was not a significant factor. Higher CHA2DS2-VASc scores and history of stroke or systemic embolism positively influenced OAC prescribing, while previous bleeding, anaemia, and higher HAS-BLED scores deterred anticoagulation. Markers of frailty and lower functional status were associated with reduced OAC prescriptions.
Conclusion: Findings support increased use of OACs and DOACs, though variability in clinical application exists. Age alone does not influence anticoagulation decisions. Higher stroke risk positively influences OAC use, while bleeding risk and frailty and lower functional status negatively influence it. Further research using consistent tools to measure frailty and functional status is warranted. Integrating comprehensive geriatric assessments and shared decision-making into clinical practice could enhance OAC prescriptions, improving clinical outcomes related to stroke prevention.