Use and Prescription of Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Multidisciplinary Consensus Document

Journal of Personalized Medicine

Barbara Scimeca¹  Luigi Gianturco²  Carlo Piemontese³  Marina Camera⁴  Antonio Gidaro⁵  Laura Adelaide Dalla Vecchia⁶  Giuseppe Pizzetti⁷  Franco Redaelli⁸  Marco Proietti⁹  Matteo Cesari⁹  Carlo Sebastiano Tadeo^1,10  Maurizio Gallieni^1,11  Giuseppe Bellelli^1,12 

[1] Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Cà Granda Maggiore Hospital Foundation, 20122 Milan, Italy;Cardiology Unit, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy;Cardiology Unit, Sant’Anna Hospital, ASST Lariana, 22042 Como, Italy;Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, University of Milan, 20157 Milan, Italy;Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy;Division of Cardiology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;Gastroenterology Unit, Valduce Hospital, 22100 Como, Italy;Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy;Istituto Clinico Città Studi, 20131 Milan, Italy;Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, 20131 Milan, Italy;School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy;

关键词: atrial fibrillation;    DOAC;    frailty;    old age;    cardiovascular prevention;    stroke;   

DOI  :  10.3390/jpm12030469

来源: DOAJ

【 摘 要 】

In the last twelve years the clinical management of patients with atrial fibrillation has been revolutionised by the introduction of direct oral anticoagulants. Despite the large amount of evidence produced, some populations remain relatively poorly explored regarding the effectiveness and safety of direct oral anticoagulants, such as the oldest and/or frailest individuals. Frailty is clinical syndrome characterized by a reduction of functions and physiological reserves which results in individuals having higher vulnerability. While current evidence underlines a relationship between atrial fibrillation and frailty, particularly in determining a higher risk of adverse outcomes, data regarding effectiveness and safety of direct oral anticoagulants in frailty atrial fibrillation patients are still lacking, leaving uncertainty about how to guide prescription in this specific subgroup. On these premises, this multidisciplinary consensus document explains why it would be useful to integrate the clinical evaluation performed through comprehensive geriatric assessment to gather further elements to guide prescription of direct oral anticoagulants in such a high-risk group of patients.

【 授权许可】

Unknown