Oral anticoagulant therapy in atrial fibrillation older patients with previous bleeding.

Oral anticoagulant therapy (OAT) with direct oral anticoagulant (DOACs) is the established treatment to reduce thromboembolic risk in patients with atrial fibrillation (AF). Bleeding risk scores are useful to identify and correct factors associated with bleeding risk in AF patients on OAT. However, the clinical scenario is more complex in patients with previous bleeding event, and the decision about whether and when starting or re-starting OAT in these patients remains a contentious issue. Major bleeding is associated with a subsequent increase in both short- and long-term mortality, and even minimal bleeding may have prognostic importance because it frequently leads to disruption of antithrombotic therapy. There is an unmet need for guidance on how to manage antithrombotic therapy after bleeding has occurred. While waiting for observational and randomized data to accrue, this paper offers a perspective on managing antithrombotic therapy after bleeding in older patients with AF.

[Safety and efficacy profile of anticoagulant therapy in elderly patients discharged from the emergency room with a diagnosis of venous thromboembolic disease: a registry study.] / Profilo di sicurezza ed efficacia della terapia anticoagulante nel paziente anziano dimesso da pronto soccorso con diagnosi di malattia trombo-embolica venosa: uno studio di registro.

BACKGROUND: Venous thromboembolism (Tev), clinically presenting as deep vein thrombosis (Tvp) or pulmonary embolism (EP), is globally the third most frequent acute cardiovascular syndrome. Reported data in literature show that the incidence of Tev is almost eight times higher in individuals aged >80 years than in the fifth decade of life. The mainstay of Tev management is anticoagulation, which should be initiated as soon as possible, provided there is no contraindication and weighing individual potential risks and benefits, in order to prevent further thrombosis and early or late complications. For decades, low molecular weight heparins (Lmwh) and vitamin K antagonists (Vkas) have been the gold standard of anticoagulation. Recently, direct oral anticoagulants (Doacs) revolutionized anticoagulation management in Tev. AIM: This real-world retrospective observational trial evaluated potential differences in safety and efficacy profiles between anticoagulation with Doacs and traditional therapy with Vkas, in the management of acute Tev in elderlies discharged from Emergency Department of Azienda ospedaliera Ordine Mauriziano in Torino. METHODS: A registry of patient evalued by the Doac-Tev ambulatory discharged by ED was compiled and analysed. RESULTS: In the population of this study (186 patients), there was a high compliance to anticoagulation, regardless the therapeutic regimen (Vka vs Doac). There was not a significant difference in the prevalence of mortality, bleeding, unplanned return to Emergency Department and in the composite safety outcome between anticoagulation regimens, with a tendency to higher rates of recurrent Tev in the Vkas group. CONCLUSIONS: A therapy with Doac in discharging elderly patient with Tev is safe and effective.