老年患者心房颤动 (AF) 患病率增加，这也显示出较高的血栓栓塞风险。建议口服抗凝剂（OAC）预防心源性栓塞事件，直接口服抗凝剂（DOAC）可改善抗血栓治疗。然而，抗凝剂对老年患者的益处/风险仍需要完全确定。这项回顾性观察研究旨在描述老年 AF 住院患者的 OAC 治疗，并使用 REgistro Politerapie SIMI 确定影响 OAC 治疗或停止的因素。应用单变量和多变量逻辑回归模型来确定 OAC 治疗和停药的预测因子。采用 Cox 比例风险模型来评估治疗组的一年死亡率。出院时 AF 患者为 1,128 例（26.5%），其中 1,098 例（97.3%）需要 OAC 治疗；其中大约一半 (N = 528;48.1 %) 是非 OAC 用户； 236 名（21.5 %）和 334 名（30.4 %）分别使用 DOAC 和 VKA。研究期间观察到 DOAC 的使用有所增加。 OACs 治疗的预测因子为：BMI（OR：1.04；95 % CI：1.01-1.07）、Barthel 指数（OR：1.01；95 % CI：1.01-1.02）、药物数量（OR：1.07；95 % CI：1.01- 1.13）。相反，高 CIR.S（OR：0.59；95 % CI：0.36-0.97）和肿瘤（OR：0.57；95 % CI：0.37-0.88）的患者发生概率较低。住院时间（OR：1.02；95 % CI：1.01-1.05）、肿瘤（OR：2.25；95 % CI：1.07-4.70）和INR（OR：1.21；95 % CI：1.05-1.40）会增加OAC的停药率。血脂异常患者（OR：0.18；95%CI：0.04-0.82）和心力衰竭患者（OR：0.38；95%CI：0.21-0.70）的停药率较低。在 AF 患者中，157 例（14.3%）在随访期间死亡。年龄（HR = 1.05；95 % CI = 1.03-1.08）和CIR.S（HR = 2.54；95 % CI = 1.53-4.21）与较高的死亡风险相关。总之，强调了与住院老年患者 OAC 治疗使用不足和停止相关的关键问题。版权所有 © 2024。由 Elsevier B.V. 出版。

Atrial fibrillation (AF) prevalence increases in older patients which also show a high thromboembolic risk. Oral anticoagulants (OACs) are recommended to prevent cardioembolic events and direct oral anticoagulants (DOACs) improved anti-thrombotic treatment. However, the benefits/risks of anticoagulant in older patients still need to be completely defined. This retrospective observational study aimed to describe the treatment with OACs in older AF hospitalized patients, and to identify factors influencing OAC therapy or discontinuation using the REgistro Politerapie SIMI. Univariate and multivariate logistic regression models were applied to identify predictors of OACs treatment and discontinuation. Cox proportional hazards models were performed to evaluate one-year mortality by treatment groups. AF patients were 1,128(26.5 %) at discharge and 1,098(97.3 %) required OAC treatment; about half of them (N = 528;48.1 %) were no-OACs users; 236(21.5 %) and 334(30.4 %) used DOACs and VKA, respectively. Increasing DOACs use was observed during the study period. Predictors of OACs treatment were: BMI (OR:1.04; 95 %CI:1.01-1.07), Barthel index (OR:1.01; 95 %CI:1.01-1.02), medications number (OR:1.07; 95 %CI:1.01-1.13). Conversely, a lower probability was found in patients with a high CIR.S (OR:0.59; 95 %CI:0.36-0.97) and neoplasm (OR:0.57; 95 %CI:0.37-0.88). Hospital stay (OR:1.02; 95 %CI:1.01-1.05), neoplasm (OR:2.25; 95 %CI:1.07-4.70) and INR (OR:1.21; 95 %CI:1.05-1.40) increased OACs discontinuation. A lower discontinuation was observed in dyslipidemic patients (OR:0.18; 95 %CI:0.04-0.82) and heart failure (OR:0.38; 95 %CI:0.21-0.70). Among AF patients, 157(14.3 %) died during the follow-up year. Age (HR = 1.05; 95 %CI = 1.03-1.08) and CIR.S (HR = 2.54; 95 %CI = 1.53-4.21) were associated with a greater mortality risk. In conclusion, critical issues related to the underuse and discontinuation of OACs therapy in hospitalized older patients were highlighted.Copyright © 2024. Published by Elsevier B.V.