Pathy's Principles and Practice of Geriatric Medicine. Группа авторов

Pathy's Principles and Practice of Geriatric Medicine - Группа авторов


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make a situational diagnosis based on the patient’s functionality and disease status. In patients with a poor prognosis approaching the end of life, the risks and burdens of anticoagulation may exceed the perceived benefits, in which case discontinuation of therapy may be appropriate.

      Key points

       When used appropriately, anticoagulants are highly effective drugs in the elderly. Age 85 or older may be an additional risk indication for anticoagulation.

       The selection of the anticoagulant drug and its dose should be carried out individually and carefully, taking into account clinical geriatric criteria and patient preferences. Evidence suggests that patients with a greater burden of comorbidities appear to spend less time within the therapeutic international normalized ratio (INR) range, resulting in a lower quality of anticoagulation therapy.

       It seems reasonable that patients who do not receive anticoagulant therapy should be limited to those with an obvious contraindication and those with a poor prognosis at the end of life.

       In patients >75, DOACs as a class were superior to warfarin with respect to both efficacy and safety, showing similar efficacy in the prevention of stroke and systemic embolization. Apixaban had the lowest risk of major bleeding, and apixaban, edoxaban, and dabigatran had lower rates of intracranial haemorrhage than rivaroxaban or warfarin.

      1 1. Tritschler T, Aujesky D. Venous thromboembolism in the elderly: A narrative review. Thromb Res. 2017; 155:140–147.

      2 2. Deitelzweig S, Keshishian A, Li X, et al. Comparisons between oral anticoagulants among older nonvalvular atrial fibrillation patients. J Am Geriatr Soc. 2019; 00:1–10.

      3 3. Lopez‐Jimenez L, Montero M, Gonzalez‐Fajardo JA, et al. RIETE Investigators. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Haematologica. 2006; 91:1046–1051.

      4 4. Poli D, Antonucci E, Testa S, et al. FCSA Italian Federation of Anticoagulation Clinics. The predictive ability of bleeding risk stratification models in very old patients on vitamin K antagonist treatment for venous thromboembolism: results of the prospective collaborative EPICA study. J Thromb Haemost. 2013; 11:1053–8.

      5 5. Méan M, Righini M, Jaeger K, et al. The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology, J Thromb. 2013; 36:475–483.

      6 6. Kirchhof P, Benussi S, Kotecha D, et al. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37:2893–2962.

      7 7. Heidenreich PA, Solis P, Estes NAM 3rd, et al. 2016 ACC/AHA clinical performance and quality measures for adults with atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2016; 68:525–68.

      8 8. Senoo K, Lau YC, Lip GY. Updated Nice guideline: management of atrial fibrillation. Expert Rev Cardiovasc Ther. 2014; 12:1037–1040.

      9 9. Lefebvre MC, St‐Onge M, Glazer‐Cavanagh M, et al. The effect of bleeding risk and frailty status on anticoagulation patterns in octogenarians with atrial fibrillation: The FRAIL‐AF Study. Can J Cardiol. 2016; 32:169–76.

      10 10. Rich MW, Chyun DA, Skolnick AH, et al. Knowledge gaps in cardiovascular care of the older adult population: a scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society. J Am Coll Cardiol. 2016; 67:2419–40.

      11 11. Edholm K, Ragle N, Rondina MT. Antihrombotic management of atrial fibrillation in the elderly. Med Clin North Am. 2015; 99:417–30.

      12 12. Sardar P, Chatterjee S, Chaudhari S, Lip GYH. New oral anticoagulants in elderly adults: evidence from a meta‐analysis of randomized trials. J Am Geriatr Soc. 2014; 62:857–864.

      13 13. Bai Y, Guo S‐D, Deng H, et al. Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta‐regression analysis. Age and Ageing. 2017; 0:1–9.

      14 14. Lip GYH, MD, Keshishian A, Li X, et al. Effectiveness and safety of oral anticoagulants among nonvalvular atrial fibrillation patients: the ARISTOPHANES study. Stroke. 2018; 49:2933–2944.

      15 15. Patti G, Lucerna M, Pecen L, et al. Thromboembolic risk, bleeding outcomes and effect of different antithrombotic strategies in very elderly patients with atrial fibrillation: a sub‐analysis from the PREFER in AF (PREvention oF Thromboembolic Events‐European Registry in Atrial Fibrillation). J Am Heart Assoc. 2017; 6(7). pii:e005657. doi:10.1161/JAHA.117.005657.

      16 16. Patti G, Pecen L, Lucerna M, et al. Net clinical benefit of non‐vitamin K antagonist vs vitamin K antagonist anticoagulants in elderly patients with atrial fibrillation. Am J Med. 2019; 132:749–757.

      17 17. Mavrakanas T, Bounameaux H. The potential role of new oral anticoagulants in the prevention and treatment of thromboembolism. Pharmacol Ther. 2011; 130:46–58.

      18 18. Naess IA, Christiansen SC, Romundstad P, et al. Incidence and mortality of venous thrombosis: a population‐based study. J Thromb Haemost. 2007; 5:692–699.

      19 19. Spencer FA, Gore JM, Lessard D, et al. Venous thromboembolism in the elderly. A community‐based perspective. Thromb Haemost. 2008; 100:780–788.

      20 20. Chugh SS, Haymoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014; 129:837–847.

      21 21. Granziera S, Cohen AT, Nante G, et al. Thromboembolic prevention in frail elderly patients with atrial fibrillation: a practical algorithm. J Am Med Dir Assoc. 2015; 16:358–6.

      22 22. Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups, J Thromb Haemost. 2010; 8:2105–2112.

      23 23. Ceriello A, Giacomello R, Stel G, et al. Hyperglycemia‐induced thrombin formation in diabetes. The possible role of oxidative stress. Diabetes. 1995; 44:924–8.

      24 24. Schulman S, Beyth RJ, Kearon C, Levine MN. Hemorrhagic complications of anticoagulant and thrombolytic treatment. American College of Chest Physicians Evidence‐Based Clinical Practice Guidelines (8th ed). Chest. 2008; 133:257S–298S.

      25 25. Rosand J, Hylek EM, O’Donnell HC, Greenberg SM. Warfarin‐associated hemorrhage and cerebral amyloid angiopathy: a genetic and pathologic study, Neurology. 2000; 55:947–951.

      26 26. Fang MC, Go AS, Hylek EM, et al. Age and the risk of warfarin‐associated hemorrhage: the anticoagulation and risk factors in atrial fibrillation study, J Am Geriatr Soc. 2006; 54:1231–1236.

      27 27. Thomas IC, Sorrentino MJ. Bleeding risk prediction models in atrial fibrillation. Curr Cardiol Rep. 2014; 16:432.

      28 28. Hijazi Z, Oldgren J, Lindbäck J, et al. The novel biomarker‐based ABC (age, biomarkers, clinical history)‐bleeding risk score for patients with atrial fibrillation: a derivation and validation study. Lancet. 2016; 387:2302–2311.

      29 29. Tavassoli N, Perrin A, Bérard E, et al. Factors associated with undertreatment of atrial fibrillation in geriatric outpatients with Alzheimer disease. Am J Cardiovasc Drugs. 2013; 13:425–433.

      30 30. O’Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015; 36:3258–3264.

      31 31. Chang G, Xie Q, Ma L, et al. Accuracy of HAS‐BLED and other bleeding risk assessment tools in predicting major bleeding events in atrial fibrillation: a network meta‐analysis. J Thromb Haemost. 2019 Nov 29. doi:10.1111/jth.14692.

      32 32. Routledge PA, Chapman PH, Davies DM, Rawlins MD. Factors affecting warfarin requirements. A prospective population study. Eur J Clin Pharmacol. 1979; 15:319–22.

      33 33. Froom


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