Related Experiment Video

Updated: Dec 15, 2025

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

84.2K

Anticoagulation decisions in elderly patients with stroke

S Deltour1, E Pautas2

  • 1Stroke center, Sorbonne university hospital, Salpêtrière hospital, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.

Revue Neurologique
|July 8, 2020
PubMed

Insights

Preventing stroke in elderly patients is complex due to age-related risks. This paper discusses anticoagulation strategies for atrial fibrillation (AF) and addresses data gaps in managing stroke in older adults.

Area of Science:

  • Geriatric Medicine
  • Neurology
  • Cardiology

Background:

  • Stroke prevention and management in the elderly present unique challenges due to increased thrombotic and hemorrhagic risks.
  • Existing data support anticoagulation for atrial fibrillation (AF) stroke prevention in older adults.
  • Significant data gaps remain regarding optimal antithrombotic management in specific elderly stroke scenarios.

Purpose of the Study:

  • To review current evidence and address challenges in primary and secondary stroke prevention for elderly patients.
  • To discuss anticoagulation decisions for stroke prevention in elderly patients with atrial fibrillation (AF).
  • To explore unresolved questions in managing elderly stroke patients, including treatment delays and post-event antithrombotic strategies.

Main Methods:

  • Review of existing literature and clinical guidelines concerning stroke prevention and management in the elderly.
  • Analysis of data supporting anticoagulation decisions in elderly patients with atrial fibrillation (AF).
  • Identification and discussion of areas with limited robust data for elderly stroke patients.

Main Results:

  • Anticoagulation is recommended for stroke prevention in elderly patients with atrial fibrillation (AF), with established oral anticoagulant therapy choices.
  • Uncertainty persists regarding optimal timing for initiating oral anticoagulation after an AF-related ischemic stroke in the elderly.
  • Management of antithrombotic treatment after cryptogenic stroke, intracranial bleeding, or high bleeding risk in elderly stroke patients requires further clarification.

Conclusions:

  • While AF-related stroke prevention in the elderly is supported by data, several critical management questions remain unanswered.
  • Further research is needed to guide antithrombotic treatment decisions in complex stroke scenarios affecting older adults.
  • Optimizing stroke prevention and management in the elderly requires addressing current evidence limitations and clinical uncertainties.

Keywords:
Benefit-risk ratioElderlyHemorrhagic riskOral anticoagulationStroke

More Related Videos

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

12.4K
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.8K

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
191
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.8K
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
138
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.4K
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
163
Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
152