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[Oral anticogulation for non-valvular atrial fibrilation in the elderly]

Fernando Veiga Fernández1, María del Rocío Malfeito Jiménez1, Sonia María Barros Cerviño1

  • 1Servicio de Geriatría, Hospital Universitario Lucus Augusti, Lugo, España.

Revista Espanola De Geriatria Y Gerontologia
|March 15, 2015
PubMed

Insights

Anticoagulation in elderly patients with non-valvular atrial fibrillation (AF) presents challenges. Non-vitamin K antagonist oral anticoagulants (NOACs) offer improved safety and efficacy, establishing them as a preferred treatment option.

Area of Science:

  • Geriatrics
  • Cardiology
  • Pharmacology

Background:

  • Anticoagulation in elderly patients with non-valvular atrial fibrillation (AF) is complex due to balancing thromboembolic and bleeding risks.
  • Elderly populations show a higher net clinical benefit from appropriate anticoagulant use compared to younger individuals.

Purpose of the Study:

  • To evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in elderly patients with non-valvular AF.
  • To develop an algorithm for selecting the optimal anticoagulant and dosage for elderly AF patients based on indirect comparisons and geriatric assessment.

Main Methods:

  • Review and indirect comparison of studies involving elderly patients with non-valvular AF treated with NOACs and VKAs.
  • Development of a novel algorithm integrating geriatric assessment, anticoagulant choice, and dosage optimization.

Main Results:

  • Studies indicate favorable outcomes for NOACs in elderly patients with non-valvular AF, suggesting they are a preferred treatment.
  • Geriatric assessment is crucial for guiding anticoagulation indication, selection, and optimization.
  • The developed algorithm aids in determining the ideal anticoagulant and dose for individual elderly AF patients.

Conclusions:

  • Non-vitamin K antagonist oral anticoagulants (NOACs) represent an advancement in thromboembolic prophylaxis for elderly individuals with non-valvular AF.
  • NOACs offer enhanced efficacy and safety, potentially replacing controversial prophylactic measures like antiplatelet agents in this demographic.

Keywords:
AncianoAnticoagulantes orales no antagonistas de la vitamina KElderlyFibrilación auricular no valvularNew oral anticoagulantsNon-valvular atrial fibrilationNon-vitamin K antagonist oral anticoagulantsNuevos anticoagulantes oralesProfilaxis tromboembólica en fibrilación auricularThromboembolic prophylaxis in atrial fibrillation.

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