Key result
Elderly patients on long-term oral anticoagulation achieved a similar mean time in therapeutic INR range compared to non-elderly patients (62.10% vs 62.50%, P=0.862) despite more co-morbidities.
Why the study?
Does older age affect the quality of oral anticoagulation management (time in therapeutic range) in patients with low formal education?
Cohort (n=171)
No
Does older age affect the quality of oral anticoagulation management (time in therapeutic range) in patients with low formal education?
Absolute Event Rate: 62.1% vs 62.5%
p-value: p=0.862
Elderly patients with low formal education and high comorbidities can achieve a similar quality of oral anticoagulation (time in therapeutic range) as younger patients.
Supports comparable TTR in elderly with low education despite comorbidities; extends evidence but remains hypothesis-generating.
BACKGROUND: despite the overwhelming evidence of its effectiveness, oral anticoagulation continues to be underused in the elderly, presumably due to physicians' misconceptions when estimating bleeding risk and ability to comply with treatment. OBJECTIVE: to investigate the quality of anticoagulation control among deprived elderly and younger patients. DESIGN: prospective observational study. SETTING: a public anticoagulation clinic in a developing country. SUBJECTS: all adult patients on intended long-term (>90 days) oral anticoagulation. We studied 171 patients (79 elderly and 92 non-elderly) with a mean follow-up of 273 ± 84.9 days. METHODS: the main outcome measure was the quality of anticoagulation management as measured by the time in therapeutic (TTR) international normalised ratio (INR) range. Elderly patients (≥60 years) were compared with younger patients with respect to the educational level and co-morbidities. RESULTS: the mean number of years of formal education was 4.37 ± 3.2 years. The mean TTR was 62.50 ± 17.9% in non-elderly and 62.10 ± 16.6% in elderly (P = 0.862) subjects, despite the higher prevalence of co-morbidities in the latter group: heart failure (46.3 versus 28.6%, P = 0.042), diabetes mellitus (22.8 versus 8.7%, P = 0.011), renal failure (estimated glomerular filtration rate <50 ml/min: 38.0 versus 7.1%, P < 0.001) and polypharmacy (84.8 versus 58.7%, P < 0.001). Fifty elderly and 84 non-elderly subjects require little or no assistance in taking medications. Among them, the elderly had lower educational levels (3.42 ± 2.5 versus 5.55 ± 3.4 years of formal education, P < 0.001) and higher rates of cognitive impairment (34.0 versus 13.1%, P = 0.004), but a similar mean TTR (62.46 ± 16.1 versus 63.02 ± 17.8%, P = 0.856). The oldest (≥75 years) patients did as well as those aged ≤50 years (mean TTR: 62.54 ± 16.0 versus 62.23 ± 16.4%, respectively, P = 0.98). CONCLUSIONS: good-quality management of oral anticoagulation is achievable in deprived populations attending an anticoagulation clinic. Elderly patients may experience similar quality of anticoagulation despite having higher levels of co-morbidities and polypharmacy. These results add evidence to the safety of such therapeutic interventions in the elderly.
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Costa et al. (2011) conducted a cohort in Long-term oral anticoagulation (n=171). Elderly age (≥60 years) vs. Non-elderly age (<60 years) was evaluated on Time in therapeutic (TTR) international normalised ratio (INR) range (p=0.862). Elderly patients on long-term oral anticoagulation achieved a similar mean time in therapeutic INR range compared to non-elderly patients (62.10% vs 62.50%, P=0.862) despite more co-morbidities.
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