Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls

Garwood, Candice L.; Corbett, Tia L.

doi:10.1345/aph.1k498

Cited by 84 publications

(39 citation statements)

References 58 publications

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“…Patients at risk for falling showed a risk of major bleedings Ϸ5-fold higher than the other patients, in agreement with previous data. 2,23,24 In particular, Gage et al, 23 examining a cohort of elderly AF patients at high risk for falling, found a similar increase in bleeding risk. However, these authors concluded that the bleeding risk did not exceed the risk of stroke and estimated that these patients appear to still benefit from anticoagulant therapy, especially if they have multiple risk factors for stroke.…”

Section: Factors Associated With Bleedingmentioning

confidence: 88%

Bleeding Risk in Very Old Patients on Vitamin K Antagonist Treatment

et al. 2011

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Background-Vitamin K antagonist (VKA) therapy is increasingly being used for the prevention of venous thromboembolism and stroke in atrial fibrillation. Bleeds are the major concern for VKA prescription, especially in very old patients who carry many risk factors for bleeding. We performed a large multicenter prospective observational study that enrolled very old patients to evaluate the quality of anticoagulation and the incidence of bleedings. Methods and Results-The study included 4093 patients Ն80 years of age who were naïve to VKA for thromboprophylaxis of atrial fibrillation or after venous thromboembolism. Patients' demographic and clinical data were collected, and the quality of anticoagulation and the incidence of bleeding were recorded. The follow-up was 9603 patient-years; median age at the beginning of follow-up was 84 years (range, 80 to 102 years). We recorded 179 major bleedings (rate, 1.87 per 100 patient-years), 26 fatal (rate, 0.27 per 100 patient-years). The rate of bleeding was higher in men compared with women (relative risk, 1.4; 95% confidence interval, 1.12 to 1.72; Pϭ0.002) and among patients Ն85 years of age compared with younger patients (relative risk, 1.3; 95% confidence interval, 1.0 to 1.65; Pϭ0.048). Time in therapeutic range was 62% (interquartile range, 49% to 75%). History of bleeding, active cancer, and history of falls were independently associated with bleeding risk in Cox regression analysis. Conclusion-In this large study on very old patients on VKA carefully monitored by anticoagulation clinics, the rate of bleedings was low, suggesting that age in itself should not be considered a contraindication to treatment. Adequate management of VKA therapy in specifically trained center allows very old and frail patients to benefit from VKA thromboprophylaxis. (Circulation. 2011;124:824-829.)

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Section: Factors Associated With Bleedingmentioning

confidence: 88%

Bleeding Risk in Very Old Patients on Vitamin K Antagonist Treatment

et al. 2011

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“…In their study, only three major bleeds directly related to a fall were reported in a cohort of 308 patients at high risk of falling, followed for 12 months [68]. A systematic review of the use of anticoagulation in elderly patients with AF at particular high risk of falls concluded that the benefits of warfarin outweigh its risks even in patients who fall, and therefore warfarin should be used, rather than aspirin or no therapy, in elderly patients at risk of falls [69]. Nevertheless, this general recommendation should not replace clinical judgment.…”

Section: Falls and Bleeding Riskmentioning

confidence: 99%

Untreated atrial fibrillation in the United Kingdom: Understanding the barriers and treatment options

Barra

Fynn

2015

Journal of the Saudi Heart Association

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major preventable cause of stroke and hospitalization. Its prevalence is on the rise worldwide and experts believe it will continue to rise for the foreseeable future, due to the ageing population and increased survival from conditions associated with AF. Despite the fact that oral anticoagulation is effective in preventing strokes due to AF, there is extensive evidence suggesting this therapy remains underused. Barriers to the prescription of anticoagulation include patients' age per se, comorbidities, inadequate risk stratification, perceived risk of falls and bleeding, and the difficulty in achieving a stable international normalized ratio (INR) on warfarin. Also, asymptomatic patients with AF may not be identified and therefore not be candidates for anticoagulation. Physicians need continued better education on the identification of patients at risk of stroke and management of oral anticoagulation. This article reviews the barriers to anticoagulation in patients with AF in the United Kingdom and considers how those barriers may be overcome.

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“…Provided no additional data on included or identified no new primary studies (n = 18) 20,[74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] Longitudinal data from RCTs evaluating other ACTs (n = 4)…”

Section: Randomised Data (Act + Apt Vs Act) (N = 5)mentioning

confidence: 99%