Key result
Prescribing oral anticoagulation in older patients with atrial fibrillation remains challenging because bleeding risk is difficult to estimate reliably, highlighting the need for stratification schemes.
Why the study?
What factors are associated with under-treatment and bleeding risk when prescribing oral anticoagulation in older patients with atrial fibrillation?
What factors are associated with under-treatment and bleeding risk when prescribing oral anticoagulation in older patients with atrial fibrillation?
Prescribing oral anticoagulation in older AF patients remains challenging due to inconsistent bleeding risk associations, emphasizing the need for robust risk stratification schemes.
Complicates OAC decisions in older AF patients; leaves open validation of improved bleeding risk stratification schemes.
BACKGROUND: Oral anticoagulation (OAC) is the most effective treatment to prevent strokes in patients with atrial fibrillation (AF). Many older patients are not prescribed OAC. OBJECTIVE: To explore which co-morbid conditions in older patients with AF have been associated with under-treatment with OAC, or were used as exclusion criteria for trials, or have been associated with increased risk of bleeding. METHODS: A Pubmed search was conducted with the terms elderly, atrial fibrillation, stroke risk, bleeding risk, intracranial haemorrhage, cognition, fall risk, renal dysfunction, alcohol abuse, malignancy, polypharmacy, NSAID, under-treatment, under-use and under-prescription. RESULTS: Higher age is associated with under-treatment. Patients with a higher risk of stroke show higher rates of bleeding complications. The associations of bleeding rates with possible contraindications are inconsistent. DISCUSSION: Published bleeding rates reflect selection bias, describing mainly relatively healthy older patients. The use of stratification schemes for stroke risk and for bleeding risk will have to be implemented. CONCLUSION: The decision to prescribe OAC in older patients with AF remains a challenging task since bleeding risk is difficult to estimate reliably. Stratification schemes may be helpful.
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Tulner et al. (2010) conducted a review in Atrial fibrillation. Oral anticoagulation (OAC) was evaluated. Prescribing oral anticoagulation in older patients with atrial fibrillation remains challenging because bleeding risk is difficult to estimate reliably, highlighting the need for stratification schemes.
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