Oral Anticoagulation Treatment in the Elderly

Palareti, Gualtiero; Hirsh, Jack; Legnani, Cristina; Manotti, Cesare; D’Angelo, Armando; Pengo, Vittorio; Moia, Marco; Guazzaloca, Giuliana; Musolesi, Serena; Coccheri, S.

doi:10.1001/archinte.160.4.470

Cited by 136 publications

(27 citation statements)

References 25 publications

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“…In our study the rate of bleeding events was not affected by age in agreement with some studies [21][22][23][24], whereas other studies reported an increased incidence of bleeding in the elderly [1,9,25,26]. As the indication for OAT in patients older than 75 years is growing wider, our finding of no increase in the risk of bleeding is of clinical relevance for the evaluation of the benefit/risk ratio of OAT in the elderly.…”

Section: Discussionsupporting

confidence: 91%

Low rate of bleeding and thrombotic complications of oral anticoagulant therapy independent of age in the real-practice of an anticoagulation clinic

Poli

Antonucci

Lombardi

et al. 2003

Blood Coagulation & Fibrinolysis

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Over past years, there has been a world-wide increase in oral anticoagulant treatment (OAT). This study was aimed at evaluating the efficacy and safety of OAT managing in a real-practice situation. Nine hundred and three consecutive unselected patients referred for the control of OAT to the Anticoagulation Clinic of the University of Florence were studied. The total follow-up period was 1679 patient-years. The rate of total, major and fatal bleeding events was 5.0, 1.1 and 0.06 per 100 patient-years, respectively. In patients with a target International Normalized Ratio (INR) > or = 3, a significantly higher rate of bleeding (P = 0.02) with respect to patients with a target INR < 3 was observed. The rate of all thrombotic events was 3.8 per 100 patient-years. The rate of major and fatal thrombotic events were 2.4 and 0.4 per 100 patient-years, respectively. At INR >/= 4.5 the rate of bleeding was significantly higher (P = 0.005) than at lower INR. At INR < 2 the rate of all thrombotic events was significantly higher (P = 0.00001) with respect to more elevated intensities of anticoagulation. A low incidence of complications may be obtained even in elderly outpatients on OAT followed at an anticoagulation clinic.

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Section: Discussionsupporting

confidence: 91%

Low rate of bleeding and thrombotic complications of oral anticoagulant therapy independent of age in the real-practice of an anticoagulation clinic

Poli

Antonucci

Lombardi

et al. 2003

Blood Coagulation & Fibrinolysis

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“…Resultados similares foram encontrados por Poli et al 17 , estudando um número maior de pacientes. Trabalhos antigos da literatura já indicavam essa falta de relação entre sangramento e sexo [49][50][51] ; outros, entretanto, indicam uma freqüência maior de hemorragias nas mulheres em uso dos AVK 37,52 .…”

Section: Discussionunclassified

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

et al. 2006

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194 ResumoObjetivo: Estudar prospectivamente a freqüência de complicações em pacientes tratados com warfarina e acompanhados no Ambulatório de Anticoagulação da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista.Métodos: Pacientes sorteados entre os agendados para consulta de junho de 2002 a fevereiro de 2004. Na primeira consulta, foi preenchida ficha com dados de identificação e clínicos. A cada retorno, ou quando o paciente procurou o hospital por intercorrência, foi preenchida ficha com a razão normatizada internacional, existência e tipo de intercorrência e condições de uso dos antagonistas da vitamina K.Resultados: Foram acompanhados 136 pacientes (61 homens e 75 mulheres), 99 com tromboembolismo venoso e 37 com doença arterial; 59 pacientes eram de Botucatu, e 77, de outros municípios. Foram registradas 30 intercorrências: nove não relacionadas ao uso da warfarina e 21 complicações hemorrágicas (38,8 por 100 pacientes/ ano). Uma hematêmese foi considerada grave (1,9 por 100 pacientes/ ano). As demais foram consideradas moderadas ou leves. Não houve óbitos, hemorragia intracraniana ou necrose cutânea. A única associação significante foi da freqüência de hemorragia com nível médio de razão normatizada internacional.Conclusão: Nossos resultados mostram a viabilidade desse tratamento em pacientes vasculares em nosso meio, mesmo em população de baixo nível socioeconômico, quando tratados em ambulatório especializado.Palavras-chave: Anticoagulantes, warfarina, efeitos adversos, doenças vasculares, trombose venosa, embolia pulmonar. AbstractObjective: To prospectively study the frequency of complications in patients treated with warfarin followed at Botucatu Medical School.Methods: Patients randomly selected among those with appointments scheduled from June 2002 to February 2004. At the first appointment, a protocol was filled with identification and clinical data. At every return or when the patient went to the hospital due to clinical events, another form was filled with the international normalized ratio, existence and type of clinical event and the conditions of use of vitamin K antagonists.Results: A total of 136 patients (61 men and 75 women), were followed; 99 patients with venous thromboembolism and 37 with arterial disease; 59 were from Botucatu and 77 were from other municipalities. Thirty clinical events were registered: nine of them were not related to the use of warfarin and 21 were hemorrhagic complications (38.8 per 100 patients-year). One hematemesis was considered severe (1.9 per 100 patients-year). The others were considered moderate or mild. There were no deaths, intracranial hemorrhage or cutaneous necrosis. The only significant association was frequency of hemorrhage and average international normalized ratio level.Conclusion: Our results demonstrate the feasibility of this treatment in vascular patients in our country, even in socially and economically poor populations, when treated in specialized clinics.

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“…Umgekehrt kann aber auch eine insuffiziente Antikoagulation das sekundäre Thromboembolierisiko statistisch signifikant erhöhen [1]. Medikamenteninteraktionen spielen in diesem Zusammenhang eine wesentliche Triggerfunktion.…”

Section: Schlussfolgerungenunclassified

Blutungskomplikationen bei geriatrischen Patienten unter oraler Antikoagulation – Aspekte der Polypragmasie

Roller

Iglseder

Dovjak

et al. 2010

Wien Med Wochenschr

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Oral anticoagulant therapy has been shown to be of benefit also in elderly patients in various therapeutic and prophylactic indications. Despite strong evidence in literature, doctors still refuse to prescribe oral anticoagulants to geriatric patients in daily routine. Main reason for this decision is the fear of secondary bleeding complications. According to clinical trial data, distinct risk factors for bleeding attributed to anticoagulant treatment may be determined: age >70 years, female gender, recurrent bleeding events, alcohol/drug abuse, diabetes, anaemia and polypharmacy. The entire article reveals the literature in Medline and Cochrane Library from 1980 to 2009 including the hits "polypharmacy - anticoagulant treatment - elderly patients". It further highlights risk assessment strategies in elderly patients, and possible pharmacokinetic and -dynamic interactions of drugs co-administered with oral anticoagulants.

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Oral Anticoagulation Treatment in the Elderly

Cited by 136 publications

References 25 publications

Low rate of bleeding and thrombotic complications of oral anticoagulant therapy independent of age in the real-practice of an anticoagulation clinic

Low rate of bleeding and thrombotic complications of oral anticoagulant therapy independent of age in the real-practice of an anticoagulation clinic

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

Blutungskomplikationen bei geriatrischen Patienten unter oraler Antikoagulation – Aspekte der Polypragmasie

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