Abstract: Objective To compare the safety and effectiveness of warfarin, dabigatran and rivaroxaban in the elderly patients with atrial fibrillation aged 65 years old and above, and to provide a reference for clinical decision-making. Methods The elderly patients with non-valvular atrial fibrillation who were hospitalized in our hospital from 2015 to 2019 were enrolled in the study. The patients were divided into three groups as 65-74 years old group, 75-84 years old group, and ≥85 years old group according to their ages, and divided into warfarin group, dabigatran group, and rivaroxaban group according to the anticoagulant treatment plan. They were followed up until the first occurrence of any embolism, bleeding event or death and the end of the study(12/31/2020). The incidence rate of end-point events among the three groups was compared. Results A total of 581 patients were finally enrolled in this study. Among them 292 were female (50.26%); 293 cases (50.43%) were 65-74 years old, 253 cases (43.55%) were 75-84 years old, 35 cases were ≥85 years old (6.02%); 301 cases received warfarin, 119 cases received dabigatran, and 161 cases received rivaroxaban. There was statistically significant difference in stroke and hemorrhoea events among different anticoagulant groups. Warfarin group had a higher risk of bleeding and embolism than dabigatran group (all P<0.05); Stratified by age, the patients receiving Warfarin in 75-84 years old group had the highest incidence rate of embolization and bleeding, followed by the patients receiving rivaroxaban and dabigatran (P<0.05). The incidence rate of embolism and bleeding had no statistical difference between different anticoagulant groups in 65-74 years old group and ≥85 years old group. Conclusions Three anticoagulant drugs show value in the elderly patients with atrial fibrillation. In elderly patients aged 75-84 years old, the safety and effect of warfarin are lower than dabigatran and rivaroxaban.

Key words: dabigatran, warfarin, rivaroxaban, aged, atrial fibrillation