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Oral anticoagulation treatment in the elderly: a nested, prospective, case-control study
G Palareti1, J Hirsh, C Legnani
1Department of Angiology, University Hospital S Orsola-Malpighi, Bologna, Italy. palareti@tin.it
Archives of Internal Medicine
|March 1, 2000
Summary
Elderly patients on oral anticoagulant treatment (OAT) face a higher risk of bleeding and fatal thrombotic events. Moderate anticoagulation (2.0-3.0 INRs) appears safest for this population.
Area of Science:
- Gerontology
- Pharmacology
- Cardiovascular Medicine
Background:
- Oral anticoagulant treatment (OAT) is crucial for preventing thrombotic events.
- The safety and efficacy of OAT in elderly populations remain a significant clinical question.
Purpose of the Study:
- To investigate the risk of bleeding and thrombotic complications in elderly patients undergoing OAT compared to younger patients.
Main Methods:
- A prospective, multicenter, inception-cohort study involving 461 elderly patients (≥75 years) and 461 younger patients (<70 years).
- Patients were matched for sex, OAT indication, and treating center.
- Bleeding and thrombotic events were meticulously recorded and analyzed.
Main Results:
- Elderly patients showed a trend towards higher bleeding (9.9% vs 6.6% patient-years) and thrombotic event rates (4.2% vs 2.5% patient-years).
- Fatal intracranial bleeding (RR 6.4) and fatal thrombotic events (RR 2.8) were significantly more frequent in the elderly.
- Lower INRs (<2.0) did not prevent bleeding or adequately protect against thrombosis in the elderly.
Conclusions:
- Elderly patients on OAT exhibit an increased risk of both bleeding and thrombotic complications.
- Intracranial hemorrhages and fatal thromboses are significantly more prevalent in older individuals.
- Targeting moderate anticoagulation (2.0-3.0 INRs) is recommended for elderly patients to optimize safety and efficacy.