The impact of age on antithrombotic use in elderly patients with non‐valvular atrial fibrillation

Abstract

Aim of study:To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients 265 years, who were admitted to a Sydney teaching hospital over a 12-month period. Results: Overall, 202 (79%) patients were discharged on some antithrombotic therapy. Patients 280 years were as likely to receive antithrombotic therapy as those c80 years (75.8% versus 81.9%, P=0.23), but a significantly lower proportion received warfarin than did those 4 0 years (25.5% versus 62.5%, Pc0.0001). Definite contraindications to anticoagulation were a significant influence on antithrombotic agent selection (P=0.04), but multivariate analysis indicated that 'old age' was the largest contributing factor: patients 280 years were 5.46 times more likely to receive aspirin in preference to warfarin than their younger counterparts (P<O.OOO 1). Conclusion: Warfarin is being withheld in AF patients 280 years for reasons other than recognised contraindications and is, therefore, potentially underutilised in the target elderly population. Further studies are necessary to determine whether this is appropriate.A purpose-designed data collection form was used to record patient demographics and medical history, stroke risk factors, clinical presentation of AF, drug therapy at B. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK study. Lancet 1989; 1 ; 175-1 79. Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of 321 -326. 40 Austraiasian Jaurnai an Ageing, Vol21 No 1 Marcn ZOO2 r e s e a r c h Aged Care Placement Consultancy ABN 63 095 41 4 81 4Placing a friend or relative in an A g e d Care Facility is a stressful, costly and time-consuming process.We can help ACPC Offers: Individually tailored program matched to specific client/family n e e d s Detailed description of aged care facilities Cost comparisons Assistance with extensive paper work Regular communication with facility and family until placement secured.

Utilisation of antithrombotic therapy for stroke prevention in atrial fibrillation in a Sydney hospital: then and now

“…Comparison with AUDIT 1 [3] Patient demographics were similar between both audits ( Table 3). The majority of patients in AUDIT 1 [3] ([70%) received an antithrombotic agent at discharge, but a significantly lower proportion of patients were prescribed warfarin at discharge (P \ 0.01).…”

“…The specific objectives were to: (1) determine the current pattern of antithrombotic use in AF patients at-risk of stroke, as reported at discharge from hospital; (2) detect any changes in the utilisation of antithrombotics between the previously published clinical audit (AUDIT 1) [3] and the current study (a period of 10 years); and (3) compare the utilisation of therapy against the recommendations of the TAG Clinical Indicator (TAG IND) [18]. This information would help document temporal changes in the use of therapy, and inform the need for further intervention, in a typical 'real world' practice setting.…”

“…A purpose-designed data collection form, based on AUDIT 1 [3], was used to collect patient demographics, medical history, AF presentation on admission, antithrombotic therapy prescribed at discharge, and potential contraindications to warfarin. Contraindications were classified as relative or definite, according to AUDIT 1 [3], and the more streamlined TAG IND [18].…”

“…Contraindications were classified as relative or definite, according to AUDIT 1 [3], and the more streamlined TAG IND [18]. Both tools used the same classification for stroke risk [1].…”

“…However, past international audits spanning many years have demonstrated that warfarin is underused for this indication [6,10,12,13,16]. In the local Australian setting, age alone has been found to be a major factor in the underutilisation of warfarin [3]. Limited interventional studies have been undertaken in an attempt to improve warfarin use in the light of these findings, consisting mostly of guideline dissemination [5,11,15].…”