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[Oral anticoagulation therapy in the elderly population with atrial fibrillation. A review article]

Roberto Petidier Torregrossa1, Pedro Abizanda Soler2, Alicia Noguerón García2

  • 1Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, España.

Revista Espanola De Geriatria Y Gerontologia
|August 4, 2018
PubMed

Insights

New oral anticoagulants are effective and safer than warfarin for elderly patients with atrial fibrillation, reducing bleeding risks. Comprehensive assessment is crucial before initiating therapy in frail older adults.

Area of Science:

  • Gerontology
  • Cardiology
  • Pharmacology

Background:

  • Aging is a significant risk factor for atrial fibrillation (AF), increasing stroke risk.
  • Elderly patients with AF face higher risks of stroke and bleeding with oral anticoagulants.
  • Common comorbidities in older adults, such as CKD and frailty, complicate anticoagulation management.

Purpose of the Study:

  • To review the role of new oral anticoagulants (NOACs) in elderly patients with AF and common comorbidities.
  • To evaluate the efficacy and safety of NOACs compared to warfarin in older populations.
  • To highlight the importance of comprehensive patient assessment before initiating anticoagulation in frail elderly individuals.

Main Methods:

  • Review of randomized trials and clinical data on NOACs in elderly patients with AF.
  • Analysis of NOAC efficacy and safety profiles in populations with comorbidities like chronic kidney disease, coronary artery disease, and frailty.
  • Assessment of factors influencing oral anticoagulant therapy decisions in older adults.

Main Results:

  • In patients aged 75 and older, NOACs demonstrated comparable or superior efficacy to warfarin.
  • NOACs consistently showed a better safety profile, particularly with reduced rates of intracranial hemorrhage.
  • Randomized trials support the use of NOACs in elderly AF patients, balancing efficacy and safety.

Conclusions:

  • NOACs represent a safe and effective oral anticoagulation option for elderly patients with atrial fibrillation.
  • Individualized, comprehensive assessment is essential to optimize NOAC therapy in frail older adults, considering stroke risk, comorbidities, and functional status.
  • NOACs offer a favorable risk-benefit profile for stroke prevention in the aging population with AF.

Keywords:
AncianoAnticoagulaciónAnticoagulantes orales directosAnticoagulationAtrial fibrillationElderlyFibrilación auricularFragilidadFrailtyNew oral anticoagulants

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