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Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants.

Turagam MK, Velagapudi P, Flaker GC - Clin Interv Aging (2015)

Bottom Line: The elderly have increased chronic kidney disease, coronary artery disease, polypharmacy, and overall frailty.For all these reasons, anticoagulant use is underutilized in the elderly.In this manuscript, the benefits of non-vitamin K antagonist oral anticoagulants compared with warfarin in the elderly patient population with multiple comorbid conditions are reviewed.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA.

ABSTRACT
Stroke prevention in elderly atrial fibrillation patients remains a challenge. There is a high risk of stroke and systemic thromboembolism but also a high risk of bleeding if anticoagulants are prescribed. The elderly have increased chronic kidney disease, coronary artery disease, polypharmacy, and overall frailty. For all these reasons, anticoagulant use is underutilized in the elderly. In this manuscript, the benefits of non-vitamin K antagonist oral anticoagulants compared with warfarin in the elderly patient population with multiple comorbid conditions are reviewed.

No MeSH data available.


Related in: MedlinePlus

Summary of choice of oral anticoagulants in elderly with various comorbidities.Abbreviations: CHA2DS2-VASc, Congestive heart failure, Hypertension, Age ≥65–74 years: 1 point and ≥75 years: 2 points, Diabetes, Stroke or transient ischemic attack, female sex, Vascular disease including peripheral vascular disease, aortic and coronary disease; CrCl, creatinine clearance; CAD, coronary artery disease; PCI, percutaneous coronary intervention; INR, international normalized ratio.
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f1-cia-10-1431: Summary of choice of oral anticoagulants in elderly with various comorbidities.Abbreviations: CHA2DS2-VASc, Congestive heart failure, Hypertension, Age ≥65–74 years: 1 point and ≥75 years: 2 points, Diabetes, Stroke or transient ischemic attack, female sex, Vascular disease including peripheral vascular disease, aortic and coronary disease; CrCl, creatinine clearance; CAD, coronary artery disease; PCI, percutaneous coronary intervention; INR, international normalized ratio.

Mentions: Stroke prevention in elderly (age ≥75 years) AF patients remains a challenge due to high risk of stroke, systemic thromboembolism, and bleeding. Despite several important advantages with NOACs, its use in an elderly patient with multiple comorbidities is limited (Figure 1). Prior to considering OAC therapy in an elderly frail patient, a comprehensive assessment including the risks and benefits, stroke risk (CHA2DS2-VASc score), baseline kidney function (CrCl), cognitive status (MMSE), mobility (Activities of Daily Living) and fall risk (Identification of Seniors at Risk score), polypharmacy, body weight/body mass index, nutritional status assessment, and life expectancy (multidimensional prognostic index) should be determined.


Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants.

Turagam MK, Velagapudi P, Flaker GC - Clin Interv Aging (2015)

Summary of choice of oral anticoagulants in elderly with various comorbidities.Abbreviations: CHA2DS2-VASc, Congestive heart failure, Hypertension, Age ≥65–74 years: 1 point and ≥75 years: 2 points, Diabetes, Stroke or transient ischemic attack, female sex, Vascular disease including peripheral vascular disease, aortic and coronary disease; CrCl, creatinine clearance; CAD, coronary artery disease; PCI, percutaneous coronary intervention; INR, international normalized ratio.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562740&req=5

f1-cia-10-1431: Summary of choice of oral anticoagulants in elderly with various comorbidities.Abbreviations: CHA2DS2-VASc, Congestive heart failure, Hypertension, Age ≥65–74 years: 1 point and ≥75 years: 2 points, Diabetes, Stroke or transient ischemic attack, female sex, Vascular disease including peripheral vascular disease, aortic and coronary disease; CrCl, creatinine clearance; CAD, coronary artery disease; PCI, percutaneous coronary intervention; INR, international normalized ratio.
Mentions: Stroke prevention in elderly (age ≥75 years) AF patients remains a challenge due to high risk of stroke, systemic thromboembolism, and bleeding. Despite several important advantages with NOACs, its use in an elderly patient with multiple comorbidities is limited (Figure 1). Prior to considering OAC therapy in an elderly frail patient, a comprehensive assessment including the risks and benefits, stroke risk (CHA2DS2-VASc score), baseline kidney function (CrCl), cognitive status (MMSE), mobility (Activities of Daily Living) and fall risk (Identification of Seniors at Risk score), polypharmacy, body weight/body mass index, nutritional status assessment, and life expectancy (multidimensional prognostic index) should be determined.

Bottom Line: The elderly have increased chronic kidney disease, coronary artery disease, polypharmacy, and overall frailty.For all these reasons, anticoagulant use is underutilized in the elderly.In this manuscript, the benefits of non-vitamin K antagonist oral anticoagulants compared with warfarin in the elderly patient population with multiple comorbid conditions are reviewed.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA.

ABSTRACT
Stroke prevention in elderly atrial fibrillation patients remains a challenge. There is a high risk of stroke and systemic thromboembolism but also a high risk of bleeding if anticoagulants are prescribed. The elderly have increased chronic kidney disease, coronary artery disease, polypharmacy, and overall frailty. For all these reasons, anticoagulant use is underutilized in the elderly. In this manuscript, the benefits of non-vitamin K antagonist oral anticoagulants compared with warfarin in the elderly patient population with multiple comorbid conditions are reviewed.

No MeSH data available.


Related in: MedlinePlus