Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation

The goals of this study were to analyze the type of  ntithrombotic treatment administered to institutionalized patients with  nonvalvular atrial fibrillation (and any ensuing complications) and to  evaluate the degree of anticoagulation control achieved with vitamin K  antagonists. Method: This was a prospective observational follow-up study  carried out in seven elderly care facilities during 2016. Patients with  nonvalvular atrial fibrillation were evaluated for their antithrombotic  therapy and any embolic or hemorrhagic events, as well as for mortality.  Subjects on anticoagulation treatment with VKAs were evaluated for  anticoagulation control, with control considered poor if the mean time in  therapeutic range was < 65% when measured with Rosendaal's method or < 60% when determined by the direct method.

Of the 699 residents evaluated, 20.6% had a diagnosis of NVAF.  Average age was 85.83 years. Both the cardioembolic (mean CHA2DS2- VASc score: 4.79), and the hemorrhagic (mean HAS-BLED score: 3.04)  risk were high. Fifty percent received anticoagulation treatment, mainly  with vitamin K antagonists, of whom at least 56% were not within the  therapeutic range. Sixteen percent of the residents, the oldest and most  functionally and cognitively dependent ones, had not been prescribed any  antithrombotic therapy. A higher frequency of hospital admissions induced  by cardiovascular and bleeding events was  found in these residents,  although differences were not statistically significant.

Half of institutionalized geriatric patients with nonvalvular atrial fibrillation are anticoagulated, a third on antiplatelet  therapy, and some without any antithrombotic treatment. This study  howed that as functionality decreases, treatment strategies are  increasingly aimed at therapeutic deintensification. Given that the degree  of anticoagulation control with vitamin K antagonists is inadequate in 56%  of cases, it is essential to monitor the time in therapeutic range to  optimize treatment as needed.