Oral anticoagulation in older patients with vascular or cardiovascular diseases. Aged over 70 years: same risk? Same...

The purpose of the study was to assess patients aged over 70 years and younger patients for possible differences in several aspects concerning anticoagulant therapy.

Two-hundred and twenty-three patients with anticoagulant treatment for an average duration of 2.6 years at an angiologic outpatient clinic were subdivided into 2 groups (above 70 years n=114; below 70 years n=109). The 2 groups were compared with regard to patient-specific data, treatment-related and compliance parameters as well as complications.

The group of older patients included a higher number of female patients, presented with a less favorable risk profile and revealed tendency or significance in showing better compliance data. No differences were found for the incidence of bleeding complications, while recurrences were more frequent in patients below the age of 70 years. Treatment-related parameters reflecting quality and stability of anticoagulant therapy (standard deviation of international ratio (INR), frequency of laboratory controls) represent predictors of bleeding risk being of more critical importance than the age of the patient. Recurrent events also showed correlation with same relevant parameters. Younger patients undergoing the same intensity of treatment for similarly distributed indications show a higher rate of recurrences.

The lower recurrence rate in older patients is consistent with the observation that anticoagulant therapy is more profitable in elderly with atrial fibrillation. Since older patients being treated with the same therapy intensity for comparable periods of time showed no higher bleeding risk than that seen for younger patients, we believe that there is no need for specific guidelines for older patients provided treatment is carefully monitored and controlled.