title: Novel anticoagulants for stroke prevention in atrial fibrillation: safety issues in the elderly.
abstract: Vitamin K antagonists (VKAs) are the most widely used anticoagulants for stroke prevention in patients with atrial fibrillation (AF). Recently, the US FDA approved three novel anticoagulants that work through inhibition of coagulation cascade independent of Vitamin K-dependent enzymatic reactions and, therefore, should have less food-drug interactions. Since AF is a disease of the aging heart, it is important to assess safety and efficacy of these new anticoagulants in elderly patients. We reviewed age-related changes in pharmacokinetics and pharmacodynamics observed with senescence and the effects of these changes on novel anticoagulants, known and anticipated drug and food interactions, and challenges related to bleeding complications and temporary discontinuation prior to surgery or interventional procedure. Although advantageous to VKA in age groups represented in trials, there are lack of data on VKA usage in older-elderly patients; additional research and post-marketing analysis in older-elderly patients are needed.
authors.affiliation: Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Aurora Health Care, 3033 South 27th Street, Milwaukee, WI, USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Strunets
authors.forename: Mahek
authors.initials: M
authors.lastname: Mirza
authors.forename: Jasbir
authors.initials: J
authors.lastname: Sra
authors.forename: Arshad
authors.initials: A
authors.lastname: Jahangir
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D006801:Humans; D020521:Stroke / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K