Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry

Gullón, Alejandra; Suárez, Carmen; Díez-Manglano, Jesús; Formiga, Francesç; Cepeda, José María; Pose, Antonio; Camafort, Miguel; Castiella, J. C.; Rovira, Eduardo; Mostaza, José María

doi:10.1016/j.medcle.2016.10.052

Cited by 4 publications

(2 citation statements)

References 32 publications

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“…The NONAVASC study was a prospective, multicenter cohort study in which 76 researchers participated from internal medicine departments from 64 Spanish hospitals …”

Section: Methodsmentioning

confidence: 99%

Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

Díez-Manglano

Mostaza²,

Pose

et al. 2018

Geriatrics Gerontology Int

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“…The NONAVASC study was a prospective, multicenter cohort study in which 76 researchers participated from internal medicine departments from 64 Spanish hospitals …”

Section: Methodsmentioning

confidence: 99%

Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

Díez-Manglano

Mostaza²,

Pose

et al. 2018

Geriatrics Gerontology Int

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“…This decision should be reassessed periodically. Only in very advanced stages should avoiding or withdrawing anticoagulation be considered 63,64 .…”

Section: Influence Of Oral Anticoagulants In the Risk Of Developing Dementiamentioning

confidence: 99%

Atrial fibrillation and dementia: Relationship, physiopathological mechanisms, and anticoagulant treatment

Espio-lvarez¹,

Vargas-Tirado²,

Surez-Fernndez³

2021

SJMED

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Atrial fibrillation (AF) and dementia are highly prevalent pathologies. In the past two decades, multiple observational studies have been published that demonstrate the causal relationship between AF and dementia. These pathologies share common vascular risk factors such as those included in CHA2DS2-VASC score. Several physiopathological mechanisms have been involved, among the theories proposed to date are: clinical stroke and silent brain infarction, cerebral hypoperfusion and vascular inflammation. Although dementia is not a contraindication for oral anticoagulation, this population is still undertreated due to fear of hemorrhagic events. More and more studies propose that the benefit of anticoagulation in patients with dementia and AF outweighs the hemorrhagic risk, due to the reduction of morbidity and mortality with a net clinical benefit. Concerning the association between effective anticoagulation therapy and the risk of developing dementia, there are data that suggest a possible beneficial effect, however, we need larger scale studies to evaluate the real influence of anticoagulant treatment in prevention of dementia. Some studies showed a borderline significant association between the use of direct oral anticoagulants and the tendency to decrease cognitive impairment when compared with warfarin therapy. There are three ongoing clinical trials to clarify whether the type and use of anticoagulants are related to the development of cognitive decline.

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Influence of frailty on anticoagulant prescription and clinical outcomes after 1-year follow-up in hospitalised older patients with atrial fibrillation

et al. 2018

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Frailty is an important prognostic factor in older adults with cardiovascular diseases. We aim to describe the characteristics of elderly hospitalised frail patients with non-valvular atrial fibrillation (NVAF) and to assess the influence of frailty, along with other functional and health status variables on anticoagulation prescription, 1-year all-cause mortality, and the incidence of ischemic and bleeding complications. An observational, prospective multicentre study was carried out on patients with NVAF over the age of 75, who were admitted to the Internal Medicine departments in Spain. A total of 615 patients were evaluated (mean age 85.23 ± 5.16 years, 54.3% females, 48.3% frail). Frail patients had higher CHA2DS2-VASc and HAS-BLED scores, more comorbidities and worse functional status and cognitive impairment compared to non-frail. During hospitalisation, 58 (9.4%) patients died (12.5% frail, 6.6% non-frail, p = 0.01). Among the participants discharged, 69.8% received anticoagulants, 13% anti-platelets only and 16.9% no anti-thrombotics, with no difference by frailty status. Frailty is not a predictor of anticoagulant prescription at discharge (OR 0.93, 95% CI 0.55-1.57), while functional dependency remains significantly associated (OR for severe dependency 0.44, 95% CI 0.23-0.82). After the 1-year follow-up, frail patients have a higher risk of death (HR 1.99, 95% CI 1.43-2.76). Among patients taking anticoagulants, the incidence of stroke and major bleeding is similar between frailty groups. In our study, frailty is related to worse global health status. It has no impact on antithrombotic prescription, nor is a predictor of AF complications, even though frail subjects have a higher mortality during hospitalisation and after 1-year follow-up.

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Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry

Cited by 4 publications

References 32 publications

Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

Atrial fibrillation and dementia: Relationship, physiopathological mechanisms, and anticoagulant treatment

Influence of frailty on anticoagulant prescription and clinical outcomes after 1-year follow-up in hospitalised older patients with atrial fibrillation

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