Challenges facing anticoagulation among the elderly and frail

Tay, Kok Hoon; Lane, Deirdre A.; Lip, Gregory Y.H.

doi:10.1093/ageing/afn295

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…While oral anticoagulants may offer the best hope of stroke prevention, this has to be tempered by a possible increase in bleeding risk and a narrowing of the therapeutic window. (160) Medications (e.g., angiotensin converting enzyme inhibitors, vitamin D, anabolic hormones, ghrelin) have been considered as potential therapies for frailty. (161,162) …”

Section: Discussionmentioning

confidence: 99%

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

et al. 2017

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There is general agreement that frailty is a state of heightened vulnerability to stressors arising from impairments in multiple systems leading to declines in homeostatic reserve and resiliency, but unresolved issues persist about its detection, underlying pathophysiology, and relationship with aging, disability, and multimorbidity. A particularly challenging area is the relationship between frailty and hospitalization. Based on the deliberations of a 2014 Canadian expert consultation meeting and a scoping review of the relevant literature between 2005 and 2015, this discussion paper presents a review of the current state of knowledge on frailty in the acute care setting, including its prevalence and ability to both predict the occurrence and outcomes of hospitalization. The examination of the available evidence highlighted a number of specific clinical and research topics requiring additional study. We conclude with a series of consensus recommendations regarding future research priorities in this important area.

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Section: Discussionmentioning

confidence: 99%

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

et al. 2017

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“…The use of any antithrombotic agent in this study significantly declined in both settings, however remained above 60%. Although prescribing of antithrombotics for stroke prevention in older people (≈ 70 years and older) is supported by the AHA and ASA [17], concerns over bleeding risk and under-representation of this population in clinical trials remains in clinical practice [25,38,39]. Warfarin, which may be used for the prevention of stroke in the setting of atrial fibrillation, increased significantly only in NHs.…”

Section: Discussionmentioning

confidence: 99%

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

et al. 2019

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Background One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time.Objective The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. Methods Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. Results Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 in NHs and 2007 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. Conclusions The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.

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“…Where possible if the thrombotic risk is greater than the bleeding risk, oral anticoagulation (not aspirin) is still the best therapy for stroke prevention 37. There is a need for further work to explore the balance of prothrombotic and antithrombotic factors in frail and non-frail older people, and to investigate if a laboratory measure of thrombotic potential can help identify those at highest risk of thrombosis 38…”

Section: Trauma In the Older Population: The Changing Landscape Of Trmentioning

confidence: 99%

Antithrombotics in trauma: management strategies in the older patients

Wong¹,

Lovett²,

Curry³

et al. 2017

JBM

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The ageing population has resulted in a change in the demographics of trauma, and older adult trauma now accounts for a growing number of trauma admissions. The management of older adult trauma can be particularly challenging, and exhibits differences to that of the younger age groups affected by trauma. Frailty syndromes are closely related with falls, which are the leading cause of major trauma in older adults. Comorbid disease and antithrombotic use are more common in the older population. Physiological changes that occur with ageing can alter the expected clinical presentation of older persons after injury and their susceptibility to injury. Following major trauma, definitive control of hemorrhage remains essential for improving outcomes. In the initial assessment of an injured patient, it is important to consider whether the patient is taking anticoagulants or antiplatelets and if measures to promote hemostasis such as reversal are indicated. After hemostasis is achieved and bleeding has stopped, longer-term decisions to recommence antithrombotic agents can be challenging, especially in older people. In this review, we discuss one aspect of management for the older trauma patients in greater detail, that is, acute and longer-term management of antithrombotic therapy. As we consider the health needs of an ageing population, rise in elderly trauma and increasing use of antithrombotic therapy, the need for research in this area becomes more pressing to establish best practice and evidence-based care.

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Challenges facing anticoagulation among the elderly and frail

Cited by 6 publications

References 17 publications

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

Antithrombotics in trauma: management strategies in the older patients

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