Anticoagulation in Older Adults with Multimorbidity

Parks, Anna L.; Fang, Margaret C.

doi:10.1016/j.cger.2016.01.003

Cited by 17 publications

(17 citation statements)

References 53 publications

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“…Use of anticoagulation increases with age-related incidence of atrial fibrillation (AF) and venous thromboembolism (VTE) 1 . Several anticoagulants are renally metabolized and require dose adjustment based on kidney function.…”

Section: Introductionmentioning

confidence: 99%

Creatinine Versus Cystatin C: Differing Estimates of Renal Function in Hospitalized Veterans Receiving Anticoagulants

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Creatinine Versus Cystatin C: Differing Estimates of Renal Function in Hospitalized Veterans Receiving Anticoagulants

et al. 2018

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“…According to studies, the mortality/morbidity risk of ischemic stroke at an advanced age is higher than the risk of anticoagulant therapy (e.g. major bleeding) (9,15). It is stated that it is not appropriate to consider "age" alone as a risk factor in the decision to start anticoagulant/antiaggregant treatment in older patients who may come to regular clinical follow-up.…”

Section: Discussionmentioning

confidence: 99%

Prognosis in Patients Who were Diagnosed as Having Stroke, Using Warfarin, and Aged Over Eighty Years: A Clinical Observation

Çelik¹,

Küçükoğlu²,

Çoban³

et al. 2020

tnd

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Objective: Warfarin treatment is a partially preferred prophylactic treatment in patients with ischemic stroke with advanced age due to possible adverse events/ drug interactions. In this study, we aimed to investigate the frequency of warfarin use, possible adverse events, and reasons for discontinuation of treatment in patients with stroke aged over 80 years. Materials and Methods: One hundred eighty-nine of 589 patients with stroke were detected retrospectively who were over 80 years and were followed up for cardioembolic stroke between 2014 and 2018. Demographic/clinical/laboratory/radiologic data together with the reasons for discontinuation of the drug were gathered from their medical records and noted in an Excel form. Results: One hundred eighty-nine patients (88 women) were included in the study. The mean duration of warfarin use was noted as 5.02±3.4 years (minimum 6 months, maximum 11 years). Ninety-four (49.7%) were treated with new oral anticoagulants in the last 2 years due to adverse events and/or social reasons, and 90 (47.6%) were on regular follow-up with warfarin. Gastrointestinal (GIS) bleeding was noted as the most common adverse event causing drug discontinuation (41.4%), and the most important risk factor for GIS symptoms was antihyperlipidemic drug use (p=0.001). Irregular hypertension was the most important risk factor for adverse events due to its triggering impact on bleeding (p<0.001). The mean international normalized ratio (INR) level during intense bleeding was calculated as 3.8±1.3. Patients with an INR level of 2.5 or higher were more likely to experience other drug-related adverse events (peripheral edema, diarrhea, shortness of breath, headache, dizziness) compared with other INR values (p=0.003). Conclusion: Especially in older stroke patients under antihyperlipidemic treatments, avoiding unnecessary drug use and making sure that the patient reaches required prophylaxis without being dependent on age is crucial.

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“…Its use in a variety of indications at an increasing rate increases warfarin-associated adverse effects in addition to its benefits. [ 1 ] Although the majority of bleedings resulting from warfarin toxicity does not cause severe clinical problems, major and life-threatening bleedings may also be observed. Studies have shown that bleeding risk grows exponentially when the international normalized ratio (INR), used to assess anticoagulant efficacy, is elevated above the therapeutic range (INR: 2.0–3.0).…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 3 ] In addition to possible complications, many factors including a fairly narrow therapeutic range, unpredictable and patient-specific dose–response, delayed onset and offset of action, slow reversal of anticoagulant effect when necessary, and interaction with diet and many medications limit warfarin use. [ 1 ]…”

Section: Introductionmentioning

confidence: 99%

“…As thromboembolic risk increases with aging, geriatric age group is the one that needs anticoagulation the most for therapeutic and prophylactic purposes. [ 1 4 ] Nevertheless, advanced age also brings about multimorbidity and polypharmacy. It has been reported that in geriatric population, the therapeutic range of warfarin could be attained in only half of time, and that the treatment is abandoned in less than a year in at least 25% of patients newly started on warfarin.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of factors affecting mortality in geriatric patients with warfarin overdose

Dağar¹,

Emektar²,

Uzunosmanoğlu³

et al. 2020

Turk J Emerg Med

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OBJECTIVES: The aim of the present study was to perform a demographic analysis of complications and to determine the factors affecting in-hospital mortality in geriatric patients with warfarin overdose. MATERIALS AND METHODS: All patients aged 65 years or older using warfarin with an international normalized ratio (INR) level above 3.5 IU between 01.01.2014 and 01.01.2018 were included in the study. Characteristics of patients with in-hospital mortality and surviving patients were compared. Multivariate regression analysis was used to assess the predictors for in-hospital mortality. RESULTS: A total of 302 geriatric patients included in the study for statistical analyses. Bleeding rate was 14.2%. A comparison of patient characteristics for in-hospital mortality (survivor vs. nonsurvivor) revealed significant differences for age, gender, chronic renal failure history, creatinine, aspartate aminotransferase (AST), and alanine aminotransferase levels ( P < 0.05). A multivariate logistic regression analysis was performed. It was found that elevated AST ( P = 0.029, odds ratio [OR]: 1.004, 95% confidence intervals [CIs]; 1.001–1.007) and creatinine ( P = 0.045, OR: 2.36, 95% CIs; 1.02–5.48) levels as well as advanced age ( P = 0.031, OR: 1.11, 95% CIs; 1.01–1.22) and male gender ( P = 0.017, OR: 5.48, 95% CIs; 1.35–22.1) had a negative impact on survival. CONCLUSION: Our study results revealed that male gender, advanced age, and hepatic and renal dysfunctions were the predictors of in-hospital mortality in the elderly with warfarin overdose. In order to avoid serious warfarin-related complications in the older age groups, particularly when there is renal or hepatic dysfunction, patients should be informed about minor warning side effects of warfarin, INR levels should be more frequently checked, and patients should have more strict follow-up schedules.

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Anticoagulation in Older Adults with Multimorbidity

Cited by 17 publications

References 53 publications

Creatinine Versus Cystatin C: Differing Estimates of Renal Function in Hospitalized Veterans Receiving Anticoagulants

Creatinine Versus Cystatin C: Differing Estimates of Renal Function in Hospitalized Veterans Receiving Anticoagulants

Prognosis in Patients Who were Diagnosed as Having Stroke, Using Warfarin, and Aged Over Eighty Years: A Clinical Observation

Assessment of factors affecting mortality in geriatric patients with warfarin overdose

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