Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach

BMC Cardiovascular Disorders

Jose María Mostaza⁴  Gregorio Tiberio⁸  Pose Reino⁶  Jesús Díez-Manglano¹  Jose CepedaRodrigo³  Miguel Camafort⁷  Francesc Formiga⁵  SuárezFernández² 

[1] Hospital Royo Villanova, Grupo de Riesgo Vascular de la SEMI, Zaragoza, España;Servicio de Medicina Interna, Hospital Universitario de La Princesa, C/Diego de León 62, Madrid, 28006, Spain;Hospital Vega Baja de Orihuela, Grupo de Riesgo Vascular de la SEMI, Orihuela, Alicante, España;Hospital Carlos III, Grupo de Riesgo Vascular de la SEMI, Madrid, España;Hospital Universitari de Bellvitge, Grupo de Riesgo Vascular de la SEMI, Hospitalet de Llobregat, Barcelona, España;Complexo Hospitalario Universitario de Santiago, Grupo de Riesgo Vascular de la SEMI, Santiago de Compostela, España;Atrial Fibrillation Unit (UFA), Internal Medicine Department, Hospital Clinic. University of Barcelona. Research Group in Cardiovascular Risk, Nutrition and Aging. Area. ‘August Pi i Sunyer‘ Biomedical Research Institute (IDIBAPS), Barcelona, Spain;Hospital Virgen del Camino, Grupo de Riesgo Vascular de la SEMI, Pamplona, España

关键词: Warfarin;    Rivaroxaban;    Elderly;    Edoxaban;    Direct oral anticoagulants;    Dabigatran;    Atrial fibrillation;    Apixaban;    Antithrombotic therapy;    Anticoagulation;   

Others  :  1230852
DOI  :  10.1186/s12872-015-0137-7

 received in 2015-04-28, accepted in 2015-10-26,  发布年份 2015

【 摘 要 】

Background

Atrial fibrillation (AF) in the elderly is a complex condition. It has a direct impact on the underuse of antithrombotic therapy reported in this population.

Discussion

All patients aged ≥75 years with AF have an individual yearly risk of stroke >4 %. However, the risk of hemorrhage is also increased. Moreover, in this population it is common the presence of other comorbidities, cognitive disorders, risk of falls and polymedication. This may lead to an underuse of anticoagulant therapy. Direct oral anticoagulants (DOACs) are at least as effective as conventional therapy, but with lesser risk of intracranial hemorrhage. The simplification of treatment with these drugs may be an advantage in patients with cognitive impairment.

The great majority of elderly patients with AF should receive anticoagulant therapy, unless an unequivocal contraindication. DOACs may be the drugs of choice in many elderly patients with AF.

Summary

In this manuscript, the available evidence about the management of anticoagulation in elderly patients with AF is reviewed. In addition, specific practical recommendations about different controversial issues (i.e. patients with anemia, thrombocytopenia, risk of gastrointestinal bleeding, renal dysfunction, cognitive impairment, risk of falls, polymedication, frailty, etc.) are provided.

【 授权许可】

   
2015 Fernández et al.

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