Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence.
Eur J Intern Med
; 41: 18-27, 2017 Jun.
Article
en En
| MEDLINE
| ID: mdl-28343849
ABSTRACT
Atrial fibrillation is more frequent in older patients, who have a higher risk of cardioembolic stroke and thromboembolism. Oral anticoagulant therapy is the standard of treatment for stroke prevention; however, under-prescription is still very common in older patients. The reasons underlying this phenomenon have not been systematically investigated, and true contraindications only partially account for it. An intimate skepticism on the real benefit-risk balance of oral anticoagulant therapy in the oldest patients seems to derive from the fact that most studies supporting it were conducted decades ago and included younger patients, with overall better functional and clinical status. In this review we will focus on the main barriers to anticoagulant therapy prescription in older patients and summarize the available evidences on the efficacy and safety of vitamin K antagonists and direct oral anticoagulants in this population. The encouraging evidence of a higher net clinical benefit of direct oral anticoagulants compared with warfarin should hopefully widen the treatment options also for frail individuals, thereby allowing a greater number of patients to be treated according to current international guidelines.
Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
/
Vitamina K
/
Warfarina
/
Fibrinolíticos
/
Anticoagulantes
Tipo de estudio:
Clinical_trials
/
Guideline
/
Systematic_reviews
Límite:
Aged
/
Humans
Idioma:
En
Revista:
Eur J Intern Med
Asunto de la revista:
MEDICINA INTERNA
Año:
2017
Tipo del documento:
Article
País de afiliación:
Italia