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Anticoagulation for stroke prevention in elderly patients with non-valvular atrial fibrillation: what are the

C W Wong1

  • 1Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Hong Kong.

Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi
|December 7, 2016
PubMed

Insights

Elderly patients with atrial fibrillation face high stroke risk. While oral anticoagulants are effective, physician concerns about bleeding in older adults often lead to underuse, necessitating safer anticoagulation strategies.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Elderly individuals with atrial fibrillation (AF) have an increased risk of stroke.
  • Oral anticoagulants (OAs) like warfarin are crucial for preventing AF-associated stroke and systemic embolism.
  • Risk stratification scores (CHADS2, CHA2D2-VASc, HAS-BLED) aid in OA decision-making and safe usage.

Purpose of the Study:

  • To address the challenges in prescribing oral anticoagulants for elderly patients with non-valvular atrial fibrillation.
  • To explore factors contributing to physician hesitancy in anticoagulation for the elderly, such as advanced age, falls, comorbidities, cognitive impairment, and polypharmacy.
  • To review alternative treatments and novel oral anticoagulants (NOACs) for AF stroke prevention in the elderly.

Main Methods:

  • Review of existing literature on anticoagulation in elderly patients with atrial fibrillation.
  • Analysis of risk factors influencing physician decisions regarding OA prescription.
  • Comparison of efficacy and safety profiles of different anticoagulant strategies, including warfarin, aspirin plus clopidogrel, and NOACs.

Main Results:

  • Elderly patients with AF are frequently undertreated with OAs due to concerns about bleeding risk.
  • Alternative strategies like low-intensity warfarin or aspirin plus clopidogrel are less effective than dose-adjusted warfarin.
  • Novel oral anticoagulants (NOACs) offer potential benefits in efficacy and convenience for AF management.

Conclusions:

  • Optimizing management of comorbidities and modifiable stroke risk factors is essential.
  • Interventions to enhance the safe use of OAs are crucial for improving stroke prevention in the elderly with AF.
  • Balancing stroke prevention and bleeding risk remains a key challenge in anticoagulation therapy for older adults with AF.

Keywords:
AgedAnticoagulants/therapeutic useAtrial fibrillation/classificationStroke

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