Original Study Vitamin K Antagonists and Direct Oral Anticoagulants in Nonagenarian Patients With Atrial Fibrillation Sergio Raposeiras-Roubín MD, PhD a, *, David Alonso Rodríguez MD, PhD b , Santiago Jesús Camacho Freire MD c , Emad Abu-Assi MD, PhD a , Rafael Cobas-Paz MD a , Carlos Rodríguez Pascual MD, PhD d , Julio García Comesaña MD e , Alberto González-Carrero López MD f , Naiara Cubelos Fernández MD b , Álvaro López-Masjuán Ríos MD c , María Cespón-Fernández MD a , Isabel Muñoz-Pousa MD a , Berenice Caneiro-Queija MD a , Adrián Rodríguez Albarrán MD c , Sara Álvarez Castañera MD b , Julia Verísimo Guillén MD d , Alberto Carpintero Vara MD d , Cristina Barreiro Pardal MD, PhD a , Pablo Domínguez-Erquicia MD a , Luis Manuel Domínguez-Rodríguez MD a , José Francisco Díaz Fernández MD c , Felipe Fernández Vázquez MD, PhD b , Andrés Iñíguez-Romo MD, PhD a a Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain b Department of Cardiology, University Hospital of Leon, Spain c Department of Cardiology, University Hospital Juan Ramón Jiménez, Huelva, Spain d Department of Geriatric Medicine, University Hospital Alvaro Cunqueiro, Vigo, Spain e Directive Staff, University Hospital, Orense, Spain f Hospital Admission Department, University Hospital Alvaro Cunqueiro, Vigo, Spain Keywords: Atrial fibrillation nonagenarian Vitamin K antagonist direct oral anticoagulants stroke major bleeding abstract Objectives: Nonagenarian patients are underrepresented in clinical trials that have evaluated oral anti- coagulation in patients with atrial fibrillation (AF). The aim of this study was to assess the pronostic impact of oral anticoagulation in patients with AF age 90 years. Design: Retrospective multicenter study of nonagenarian patients with AF. Setting and participants: A total of 1750 nonagenarian inpatients and outpatients with nonvalvular AF between January 2013 and December 2018 in 3 Spanish health areas were studied. Methods: Patients were divided into 3 groups based on antithrombotic therapy: nonoral anticoagulants (30.5%), vitamin-K antagonists (VKAs; 28.6%), and direct oral anticoagulants (DOACs; 40.9%). During a mean follow-up of 23.6  6.6 months, efficacy outcomes (death and embolic events) were evaluated using a Cox regression analysis and safety outcomes (bleeding requiring hospitalization) by competing- risk regression. Results were complemented with a propensity score matching analysis. Results: During follow-up, 988 patients died (56.5%),180 had embolic events (10.3%), and 186 had major bleeding (10.6%). After multivariable adjustment, DOACs were associated with a lower risk of death and embolic events than nonanticoagulation [hazard ratio (HR) 0.75, 95% confidence interval (CI)] 0.61‒0.92), but VKAs were not (HR 0.87, 95% CI 0.72‒1.05). These results were confirmed after propensity score matching analysis. For bleeding, both DOACs and VKAs proved to be associated with a higher risk (HR for DOAC 1.43; 95% CI 0.97‒2.13; HR for VKA 1.94; 95% CI 1.31‒2.88), although findings for DOACs were not statistically significant (P ¼ .074). For intracranial hemorrhage (ICH), only VKAsdnot DOACsdpresented a higher risk of ICH (HR 4.43; 95% CI 1.48‒13.31). The authors declare no conflicts of interest. * Address correspondence to Sergio Raposeiras-Roubín, MD, PhD, Department of Cardiology, University Hospital Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Pontevedra, Spain. E-mail address: raposeiras26@hotmail.com (S. Raposeiras-Roubín). https://doi.org/10.1016/j.jamda.2019.08.033 1525-8610/Ó 2019 AMDA e The Society for Post-Acute and Long-Term Care Medicine. JAMDA journal homepage: www.jamda.com JAMDA xxx (2019) 1e7