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154 with a history of serious gastrointestinal or in‐ tracranial bleeding, known cancer, hemoglo‐ bin levels of less than 9 g/dl, thrombocytope‐ nia (<50 × 103/μl), chronic kidney disease stage 5, or potent drug–drug interactions. All patients were recruited in outpatient clinics at John Paul II Hospital in Kraków, Poland. The study protocol was approved by the bioethics com‐ mittee, and all patients gave informed consent to participate in the study. The HAS ‐BLED and CHA2DS2‐VASc scores were used to evaluate bleeding and thromboem‐ bolic risk, respectively. Definitions of all comor‐ bidities were derived from our previous study.9 Major bleeding and clinically relevant nonma‐ jor bleeding (CRNMB) were defined according to International Society on Thrombosis and He‐ mostasis criteria.10 Patients were followed on a 6‐month basis (a visit at the center or telephone contact). We recorded the incidence of ischemic stroke, tran‐ sient ischemic attack, systemic embolism, and bleeding. Stroke was diagnosed based on the oc‐ currence of a new and abrupt focal neurologic deficit persisting for more than 24 hours and confirmed by positive imaging findings. Tran‐ sient ischemic attack was defined as a transient episode of neurologic dysfunction caused by fo‐ cal brain, spinal cord, or retinal ischemia, last‐ ing less than 24 hours. Apart from routine laboratory investiga‐ tions, electrochemiluminescence immunoas‐ says (Roche Diagnostics, Mannheim, Germany) were used to measure growth differentiation factor 15 (GDF‐15) and N ‐terminal fragment of Introduction Non–vitamin K antagonist oral anticoagulants (NOACs) are increasing‐ ly used in atrial fibrillation (AF), regardless of age, and they are now preferred over vitamin K antagonists (VKAs).1 Atrial fibrillation occurs in 10% to 17% of the population over 80 years old1,2 and increases the risk of ischemic stroke at least 4 fold.3 While treating very elderly patients with NOACs, it is important to consider several con‐ comitant diseases such as increased risk of falls, dementia, chronic kidney disease, and liver dis‐ ease as well as drug–drug interactions to ensure the safety of anticoagulation.4 A large global registry showed that 82.3% of patients over 85 years with newly diagnosed AF receive anticoagulation, of which nearly 46% are treated with NOACs,5 most commonly with apixaban.6 The current European Society of Car‐ diology guidelines indicate that very elderly pa‐ tients with AF do better on oral anticoagulants than not and on NOACs rather than VKAs.7 In el‐ derly patients with AF, safety concerns repre‐ sent the main reason for insufficient use of oral anticoagulants.8 The aim of this case series was to evaluate the efficacy and safety of apixaban, rivaroxa‐ ban, and dabigatran in real ‐life AF patients aged 85 years or older, who were followed at a single institution on a long ‐term basis.

Efficacy and safety of non–vitamin K antagonist oral anticoagulants in very elderly patients with atrial fibrillation: a single-center experience