Warfarin therapy in elderly patients with atrial fibrillation achieved therapeutic INR in 51% of tests, with female gender and cognitive/functional impairment associated with supratherapeutic INR.
Observational (n=18)
What are the outcomes and challenges of warfarin therapy for stroke prevention in community-dwelling elderly patients with atrial fibrillation?
In very elderly patients with atrial fibrillation, achieving therapeutic anticoagulation is feasible but complicated by cognitive and functional impairments, underscoring the need for caregiver support.
OBJECTIVE: To evaluate a clinical practice model that addresses special needs for managing anticoagulation in a community-dwelling elderly population with atrial fibrillation and high risk of stroke. METHODS: Medical records of 18 patients (mean age 82 y) followed by the Geriatric Ambulatory Program over 2 years, with a target international normalized ratio (INR) of 2.0-3.0, were reviewed. Risk factors for stroke, number and results of INR tests, suspected reasons for suboptimal response, and adverse events were analyzed. Patients were defined as having cognitive impairment if they had a Folstein Mini-Mental State Exam score or = 2 disabilities in activities of daily living. RESULTS: Eighty-three percent (15/18) had > or = 2 additional stroke risk factors. Fifty-one percent (273/541) of INR responses were therapeutic. Female gender (p = 0.015) and cognitive (p = 0.019) and functional impairment (p = 0.001) were associated with supratherapeutic INR response. All patients with cognitive impairment and 85% of those with functional impairment received caregiver support for medication administration. There were 4 minor bleeding events and no thromboembolic events. The mean number of medications was 9.3 in those with bleeding versus 6.8 in those without bleeding (p = 0.052). CONCLUSIONS: Elderly patients with high stroke risk achieved therapeutic INR responses. However, those with significant cognitive or functional impairment require caregiver support and special consideration for anticoagulation management.
Lackie et al. (2002) conducted an observational in Atrial fibrillation (n=18). Warfarin therapy was evaluated on Therapeutic INR response. Warfarin therapy in elderly patients with atrial fibrillation achieved therapeutic INR in 51% of tests, with female gender and cognitive/functional impairment associated with supratherapeutic INR.