Examination of anticoagulation prescription among elderly patients with atrial fibrillation after in-hospital fall

Chukwuemeka, Andrew; Bulsara, Kishen; Izard, Stephanie; Delicce, Anthony; Smith, Alexander; Kim, Young Ho

doi:10.1007/s11239-021-02555-8

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…Then 13 remaining studies need to be assessed in more detail. Ten studies ( 11 , 12 , 17 – 24 ) were excluded because (1) mathematical model ( n = 3); (2) case-control study ( n = 1); (3) participants without AF ( n = 1); (4) intervention is only warfarin ( n =1); (5) studies without available data ( n = 1); (6) studies' outcomes are the risk of falling ( n = 2); (7) studies' outcomes are prescriptions ( n = 1). Finally, a total of three cohort studies ( 25 – 27 ) were included in our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The advantage of DOACs over warfarin in reducing SSEs, hemorrhagic stroke, all-cause mortality, and intracranial hemorrhage has been studied by several previous studies ( 10 ). The risk of falling should not be a decisive factor for withholding anticoagulation as nowadays' anticoagulation guidelines seem to pay more attention to bleeding complications than the risk of stroke ( 11 , 12 ). In addition, the evidence certifying the deleterious effects of warfarin and DOACs on bone health is insufficient ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Direct Oral Anticoagulants vs. Vitamin K Antagonists in Atrial Fibrillation Patients at Risk of Falling: A Meta-Analysis

Gao

Huang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDirect oral anticoagulants (DOACs) and warfarin are usually used for people with atrial fibrillation (AF). However, for the AF patients at risk of falling, the effectiveness and safety outcomes of DOACs compared with warfarin remain unclear. Therefore, we performed a meta-analysis regarding the effectiveness and safety of DOACs vs. warfarin in AF patients at risk of falling.MethodsA search of the PubMed and Embase databases until November 2021 was performed. We included studies if they satisfied the following criteria: (1) study type: randomized clinical trials or observational cohort studies. (2) Comparisons: effectiveness and/or safety of DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) compared with warfarin. (3) Study data: the sample size, the number of events in the VKAs or DOACs groups, adjusted risk ratios (RRs), and 95% confidence intervals (CIs). (4) Study outcomes: stroke or systemic embolism (SSE), ischemic stroke, myocardial infarction (MI), all-cause death, and cardiovascular death; major bleeding, major or clinically relevant non-major (CRNM) bleeding, intracranial bleeding, gastrointestinal bleeding, and any bleeding. (5) Study population: patients at risk of falling. According to the Morse Fall Scale, the risk of falling relates to the history of falling, secondary diagnosis, ambulatory aids, intravenous therapy, type of gait, and mental status. In this meta-analysis, if the patient's MFS score is ≥25 points, he will be thought of as having the risk of falling. The adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were pooled by a random-effects model with an inverse variance method.ResultsThree cohort studies were included in our study. For the effectiveness outcomes, the use of DOACs was only associated with a significantly reduced risk of hemorrhagic stroke (RR = 0.28, 95%CI:0.10–0.75) compared with warfarin, but there were no significant differences in stroke or systemic embolism (SSE) (RR = 0.87, 95%CI:0.70–1.08), cardiovascular death (RR = 0.97, 95%CI:0.73–1.29) and all-cause death (RR = 0.90, 95%CI:0.72–1.11). For the safety outcomes, the use of DOACs was significantly associated with reduced risks of major or clinically relevant non-major bleeding (RR = 0.77, 95%CI:0.61–0.98) and intracranial bleeding (RR = 0.26, 95%CI:0.11–0.66) but not major bleeding (RR = 0.78, 95%CI:0.58–1.06).ConclusionsCompared with warfarin, the use of DOACs in AF patients at risk of falling is significantly associated with reduced risks of hemorrhagic stroke, major or clinically relevant non-major bleeding, and intracranial bleeding.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Direct Oral Anticoagulants vs. Vitamin K Antagonists in Atrial Fibrillation Patients at Risk of Falling: A Meta-Analysis

Gao

Huang

et al. 2022

Front. Cardiovasc. Med.

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Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review

Vazquez,

Yates,

Beavers

et al. 2024

J Thromb Thrombolysis

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Anticoagulation therapy is standard for conditions like atrial fibrillation, venous thromboembolism, and valvular heart disease, yet it is unclear if there are ethnoracial disparities in its quality and delivery in the United States. For this scoping review, electronic databases were searched for publications between January 1, 2011 – March 30, 2022. Eligible studies included all study designs, any setting within the United States, patients prescribed anticoagulation for any indication, outcomes reported for ≥ 2 distinct ethnoracial groups. The following four research questions were explored: Do ethnoracial differences exist in 1) access to guideline-based anticoagulation therapy, 2) quality of anticoagulation therapy management, 3) clinical outcomes related to anticoagulation care, 4) humanistic/educational outcomes related to anticoagulation therapy. A total of 5374 studies were screened, 570 studies received full-text review, and 96 studies were analyzed. The largest mapped focus was patients’ access to guideline-based anticoagulation therapy (88/96 articles, 91.7%). Seventy-eight articles made statistical outcomes comparisons among ethnoracial groups. Across all four research questions, 79 articles demonstrated favorable outcomes for White patients compared to non-White patients, 38 articles showed no difference between White and non-White groups, and 8 favored non-White groups (the total exceeds the 78 articles with statistical outcomes as many articles reported multiple outcomes). Disparities disadvantaging non-White patients were most pronounced in access to guideline-based anticoagulation therapy (43/66 articles analyzed) and quality of anticoagulation management (19/21 articles analyzed). Although treatment guidelines do not differentiate anticoagulant therapy by ethnoracial group, this scoping review found consistently favorable outcomes for White patients over non-White patients in the domains of access to anticoagulation therapy for guideline-based indications and quality of anticoagulation therapy management. No differences among groups were noted in clinical outcomes, and very few studies assessed humanistic or educational outcomes. Graphical Abstract Scoping Review: Differences in quality of United States anticoagulation care delivery by ethnoracial group. AF = atrial fibrillation; AMS = anticoagulation management service; DOACs = direct oral anticoagulants; INR = international normalized ratio; PSM = patient self-management; PST = patient self-testing

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Examination of anticoagulation prescription among elderly patients with atrial fibrillation after in-hospital fall

Cited by 2 publications

References 29 publications

Direct Oral Anticoagulants vs. Vitamin K Antagonists in Atrial Fibrillation Patients at Risk of Falling: A Meta-Analysis

Direct Oral Anticoagulants vs. Vitamin K Antagonists in Atrial Fibrillation Patients at Risk of Falling: A Meta-Analysis

Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review

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