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Oral anticoagulation in elderly adults with atrial fibrillation: integrating new options with old concepts

Ignatius Gerardo E Zarraga1, Jack Kron

  • 1Division of Cardiology, Portland Veterans Affairs Medical Center, Portland, Oregon 97239, USA. Ignatius.Zarraga@va.gov

Journal of the American Geriatrics Society
|December 21, 2012
PubMed

Insights

Oral anticoagulation is crucial for preventing stroke in elderly patients with atrial fibrillation (AF). This review addresses barriers to its use, including bleeding risks and physician perceptions, to improve treatment strategies.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Atrial fibrillation (AF) is a common cardiac arrhythmia, particularly in the elderly, and a significant stroke risk factor.
  • Oral anticoagulation effectively prevents thromboembolic events but faces underuse challenges in older adults.
  • Addressing these challenges is vital for optimizing stroke prevention in the elderly AF population.

Purpose of the Study:

  • To synthesize current literature on anticoagulation in elderly adults with AF.
  • To identify and address barriers to oral anticoagulation therapy in this demographic.
  • To review risk stratification schemes and available antithrombotic therapies for AF.

Main Methods:

  • Comprehensive PubMed literature search (1990-2012) using keywords: atrial fibrillation, elderly, antiplatelet, anticoagulation, stroke, bleeding, hemorrhage, falls.
  • Manual bibliography search of retrieved articles.
  • Synthesis of data to address key clinical questions.

Main Results:

  • Underuse of oral anticoagulation in elderly AF patients is linked to complex issues including fall risk, warfarin responsiveness, and physician-perceived risks.
  • Risk-stratification schemes for stroke and hemorrhage can refine antithrombotic therapy selection.
  • Data on antiplatelet, warfarin, and novel oral anticoagulant use in AF are summarized.

Conclusions:

  • Optimizing anticoagulation in elderly patients with AF requires addressing specific barriers and utilizing refined risk assessment tools.
  • Understanding physician perceptions and patient-specific risks is crucial for effective treatment.
  • Current evidence supports various antithrombotic options, including new oral anticoagulants, for AF management.

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