OBJECTIVEThe relationship between stroke/thromboembolic events (TEs) and bleeding as well as age-related risk factors are not fully clear in elderly patients with atrial fibrillation (AF). This study aimed to evaluate the clinical features, incidence and risk factors of stroke and bleeding in elderly AF patients.

METHODA total of 220 elderly AF patients [mean age (83.1 ± 0.6) years] were followed for (3.2 ± 0.8) years. The CHA(2)DS(2)-VASc score, the HAS-BLED score, annual major bleeding risk and the annual stroke were analyzed.

RESULTThe CHA(2)DS(2)-VASc score in patients with 65-79, 80-89 and ≥ 90 years old groups were 2.9 ± 0.2, 5.2 ± 0.2 and 5.6 ± 0.2, respectively (P < 0.001) and the HAS-BLED score were 2.1 ± 0.1, 3.2 ± 0.1 and 3.6 ± 0.1, respectively (P < 0.001), both significantly increased with aging. The annual major bleeding risk increased similarly as the annual stroke risk in the very elderly AF patients (patients 80-89 years old: bleeding risk 3.7 %, stroke risk 6.7 %; patients ≥ 90 years old: 8.7 % and 9.8 %, respectively). The combination of CHA(2)DS(2)-VASc and HAS-BLED could identify those patients with high risk for stroke and bleeding correctly. Twelve (5.5%) patients experienced "bidirectional events" (concomitant TE and haemorrhage), of whom 9 (75.0 %) suffered recurrent TEs.

CONCLUSIONThe bleeding risk increased similarly as the thromboembotic risk with increasing age in the elderly AF patients, "bidirectional events" is not common but related with worse outcome in elderly AF patients.