Oral anticoagulation therapy in elderly patients (≥80 years) with cardioembolic stroke resulted in a 12.5% rate of systemic hemorrhage and no intracranial hemorrhages over a mean follow-up of 19.5 months.
Observational (n=159)
No
Is oral anticoagulant therapy safe and effective for secondary prevention of cardioembolic strokes in elderly patients (≥80 years)?
Oral anticoagulation appears to be a safe strategy for secondary prevention of cardioembolic stroke in patients over 80 years old when carefully monitored, as bleeding and recurrence events were primarily associated with out-of-range INRs.
BACKGROUND: Stroke incidence increases with age. Atrial fibrillation (AF) is an important risk factor for ischemic stroke and its incidence also increases with age. However oral anticoagulant therapy (OAT) tends to be underused in the elderly population. METHODS: Elderly patients (> = 80 years) with an ischemic stroke admitted in our department between 1/7/2003 and 31/6/2005 were prospectively evaluated. Baseline characteristics, risk factors, treatment and etiology according to TOAST criteria were recorded. Patients treated with OAT were followed up in order to assess any side effect and stroke recurrence. Mean follow-up was of 19.5 months (7-45) from discharge. RESULTS: Sixty four out of a hundred and fifty nine elderly patients (40.25%) were classified as cardioembolic; mean age was 84.5 years (80-97) and 64.6% were women. AF had been previously identified in 60% of them (16.9% were on OAT and 40.6% on antiplatelet therapy). At discharge, 32 patients (49.2%) were on OAT. In the follow-up 4 patients (12.5%) suffered systemic haemorrhages (3 urinary, 1 gastrointestinal bleeding), with no change in their functional status. Mean INR in this group was 5.9 34567891011 and, in 3 of them, OAT was cancelled. No brain haemorrhages were recorded. Ischemic stroke recurred in 4 patients (INR 80 years. The high proportion of cardioembolic strokes in this age segment contrasts with the general underuse of OAT as antithrombotic prophylaxis. Our study suggests that OAT is a safe strategy when carefully prescribed, even for elderly patients.
Benavente et al. (Fri,) conducted a observational in Ischemic stroke or transient ischemic attack (n=159). Oral anticoagulation was evaluated on Systemic haemorrhages. Oral anticoagulation therapy in elderly patients (≥80 years) with cardioembolic stroke resulted in a 12.5% rate of systemic hemorrhage and no intracranial hemorrhages over a mean follow-up of 19.5 months.