Key result
Anticoagulant therapy in frail patients with atrial fibrillation can provide net clinical benefits by reducing stroke risk, which often outweighs the risks of bleeding and falls when modifiable risk factors are managed.
Why the study?
Anticoagulant therapy is often underused in frail AF patients due to concerns about falls and bleeding, despite their higher stroke risk and potential prognostic benefit.
Does anticoagulant therapy improve prognosis and reduce stroke without excessive bleeding in frail elderly patients with atrial fibrillation?
Does anticoagulant therapy improve prognosis and reduce stroke without excessive bleeding in frail elderly patients with atrial fibrillation?
Anticoagulant therapy, especially DOACs, should not be withheld in frail elderly patients with AF solely due to age or fall risk, as the net clinical benefit favors stroke prevention.
Answers are grounded in this paper and cite their sources.
Anticoagulation decisions in frail AF warrant individualized risk-benefit assessment; leaves open need for RCTs to guide therapy.
The prevalence of atrial fibrillation (AF) increases with age, as does the proportion of patients with frailty. AF patients with frailty have a higher risk of stroke than those without frailty, and progressive frailty caused by stroke is also associated with a worse prognosis. Despite this, anticoagulant therapy tends to not be used in frail patients because of the risk of falls and bleeding complications. However, some studies have shown that anticoagulant therapy improves the prognosis in patients with frailty. An accurate assessment of the "net-clinical-benefits" is needed in patients with frailty, with the aim of improving the prognoses of patients with frailty by selecting those who will benefit from anticoagulant therapy and actively reducing the risk of bleeding. A comprehensive intervention that includes a team of doctors and social resources is required. We herein review the effectiveness and bleeding risk associated with anticoagulant therapy in frail patients investigated in clinical studies.
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Hori et al. (2021) conducted a review in Atrial Fibrillation and Frailty. Anticoagulant therapy was evaluated. Anticoagulant therapy in frail patients with atrial fibrillation can provide net clinical benefits by reducing stroke risk, which often outweighs the risks of bleeding and falls when modifiable risk factors are managed.
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