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[Atrial fibrillation and thromboprophylaxis in elderly patients]

I Jörg1, J Harenberg, T Fenyvesi

  • 1IV. Medizinische Klinik, Universitätsklinik Mannheim, Fakultät für Klinische Medizin der Universität Heidelberg, Mannheim, Germany.

Zeitschrift Fur Kardiologie
|January 28, 2005
PubMed

Insights

Elderly patients with atrial fibrillation face higher stroke and bleeding risks. Ximelagatran, an oral direct thrombin inhibitor, showed similar stroke prevention to warfarin but with fewer bleeding events, offering a potential alternative.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Chronic, nonvalvular atrial fibrillation (AF) incidence increases with age, raising ischemic stroke risk.
  • Current guidelines recommend anticoagulation for AF patients, but bleeding risks and falls in the elderly limit treatment.
  • Oral anticoagulants, including vitamin K antagonists, pose challenges for older adults due to increased bleeding and fall risks.

Purpose of the Study:

  • To evaluate the efficacy and safety of ximelagatran, an oral direct thrombin inhibitor, as an alternative anticoagulant therapy.
  • To compare stroke and bleeding complication rates between ximelagatran and warfarin in patients with atrial fibrillation.
  • To assess the potential benefits of ximelagatran for elderly patients at risk of bleeding or falls.

Main Methods:

  • A comparative study involving patients with chronic, nonvalvular atrial fibrillation.
  • Treatment groups received either ximelagatran (2x36 mg daily) or warfarin for 18 months.
  • Efficacy endpoints included rates of ischemic stroke and systemic embolism; safety endpoints focused on bleeding complications.

Main Results:

  • Ximelagatran demonstrated comparable efficacy to warfarin in preventing ischemic strokes and systemic embolism (1.6%/year for both).
  • All bleeding complications occurred significantly less frequently in patients treated with ximelagatran compared to warfarin.
  • The reduced bleeding profile of ximelagatran may be particularly beneficial for elderly patients with increased bleeding or fall risks.

Conclusions:

  • Ximelagatran offers a safe and effective alternative to warfarin for stroke prevention in patients with atrial fibrillation.
  • The lower incidence of bleeding complications with ximelagatran is a significant advantage, especially for the elderly and those with bleeding risks.
  • Direct thrombin inhibitors like ximelagatran represent a promising therapeutic option for managing atrial fibrillation in aging populations.

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