The impact of frailty on coagulation and responses to warfarin in acute older hospitalised patients with atrial fibrillation: a pilot study

Abstract

In this cohort of acute hospitalised patients with AF, the observed decreased fibrin generation in the frail may reflect decreased acute phase response as suggested with the lower plasma fibrinogen in that group. There was no difference in coagulation profiles between the frail and the non-frail amongst those taking warfarin. Compared to young healthy volunteers, older inpatients had increased fibrin generation and decreased thrombin generation. The findings reflect the complex interaction between age, frailty, acute illness, and coagulation.

Influence of Age on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage

“…In this scenario, factors other than PTTR such as poor hypertension control may potentially be responsible for the high hemorrhagic risk. Another possible explanation may be age‐related frailty where the deterioration in normal bodily functions plays a role in precipitating adverse outcomes . Although aiming for a lower INR target range (1.6–2.6) in patients older than 70 years may reduce the bleeding risk, it may also limit effectiveness .…”

“…Another possible explanation may be age-related frailty where the deterioration in normal bodily functions plays a role in precipitating adverse outcomes. 49,50 Although aiming for a lower INR target range (1.6-2.6) in patients older than 70 years may reduce the bleeding risk, 51, 52 it may also limit effectiveness. 53 Based on current evidence, the benefits of warfarin therapy (INR 2-3) still outweigh the risks even in elderly patients.…”

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

“…It is found in approximately half of the patients undergoing TAVI 45. In frail individuals, fibrin generation is reduced46 and the risk of major bleeding is increased independently of age 47. Anticoagulation is often avoided given the perceived fall risk that has been associated with bone fractures, bleeding events and mortality 48.…”

How to write an integrative review: contextualization in the health care of the elderly

“…On this occasion, the authors suggested that concepts should be approached in order to confront the social determinants and solution of social problems addressed by the elderly, in order to guarantee the valuation of the elderly in different contexts and also as subjects of rights and, in the community, as co-responsible for the promotion of healthy, successful aging. 13 Well-being in old age, or health, is demonstrated in the participation of the elderly in social, economic, spiritual, cultural and civil activities. The term is seen as the result of the balance between the various dimensions of the functional capacity of the elderly, without necessarily signifying the absence of problems in all dimensions.8 Healthy aging, also called successful aging, prioritizes low risk of diseases and of functional disabilities related to them, mental and physical functioning and active involvement with life.…”