title: Antithrombotic Therapy Practices in Older Adults Residing in the Long-Term Care Setting.
abstract: OBJECTIVE
  To explore physician practice patterns with regard to antithrombotic therapy, including antiplatelets and anticoagulants, in long-term care residents and compare resulting embolic complications.
  
  
  METHODS
  Conducted between August 2012 and March 2013, this study was a retrospective chart review of 400 residents of a long-term care facility. Electronic charts from October 2005 through January 2013 were selected using systematic random sampling.
  
  
  RESULTS
  Approximately one-third of residents (29.6%) received anticoagulants, 27.3% received antiplatelets, 15.8% received both, and 27.3% did not receive any antithrombotic therapy. The most commonly prescribed antithrombotic drugs were aspirin (37.5%) and warfarin (22.1%). The type of antithrombotic therapy was significantly associated with medical history, including deep vein thrombosis (P = 0.03), the presence of atrial fibrillation (P = 0.001) and other nonsurgical medical conditions (P = 0.0001). Weight (P = 0.009) and body mass index (P = 0.007) also were significantly associated with type of antithrombotic therapy, indicating that heavier residents and those with a higher body mass index were more likely to receive both anticoagulants and antiplatelets. There was no difference in the number of embolic complications among groups.
  
  
  CONCLUSIONS
  Physicians are more disposed to initiate and maintain residents on aspirin while being more cautious when prescribing anticoagulants such as warfarin, dabigatran, heparin, and enoxaparin. In some residents, anticoagulants were not used at all, even when residents had particular risk factors, demonstrating that at times physicians may err on the side of overcautiousness. Antithrombotic therapy should be individualized for each resident based on bleeding risk, comorbidities, and benefits of a particular therapy for our most vulnerable populations.
authors.affiliation: From the Departments of Geriatrics, Medicine, and Cardiology, North Shore-LIJ Health System, Great Neck, New York, the Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York, and the Department of Cardiology, Nassau University Medical Center, East Meadow, New York.
authors.forename: Win
authors.initials: W
authors.lastname: Oo
authors.affiliation: From the Departments of Geriatrics, Medicine, and Cardiology, North Shore-LIJ Health System, Great Neck, New York, the Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York, and the Department of Cardiology, Nassau University Medical Center, East Meadow, New York.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kozikowski
authors.affiliation: From the Departments of Geriatrics, Medicine, and Cardiology, North Shore-LIJ Health System, Great Neck, New York, the Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York, and the Department of Cardiology, Nassau University Medical Center, East Meadow, New York.
authors.forename: Joanna
authors.initials: J
authors.lastname: Stein
authors.affiliation: From the Departments of Geriatrics, Medicine, and Cardiology, North Shore-LIJ Health System, Great Neck, New York, the Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York, and the Department of Cardiology, Nassau University Medical Center, East Meadow, New York.
authors.forename: James
authors.initials: J
authors.lastname: Lolis
authors.affiliation: From the Departments of Geriatrics, Medicine, and Cardiology, North Shore-LIJ Health System, Great Neck, New York, the Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York, and the Department of Cardiology, Nassau University Medical Center, East Meadow, New York.
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.affiliation: From the Departments of Geriatrics, Medicine, and Cardiology, North Shore-LIJ Health System, Great Neck, New York, the Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York, and the Department of Cardiology, Nassau University Medical Center, East Meadow, New York.
authors.forename: Amgad N
authors.initials: AN
authors.lastname: Makaryus
authors.affiliation: From the Departments of Geriatrics, Medicine, and Cardiology, North Shore-LIJ Health System, Great Neck, New York, the Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York, and the Department of Cardiology, Nassau University Medical Center, East Meadow, New York.
authors.forename: Gisele
authors.initials: G
authors.lastname: Wolf-Klein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy*; D015992:Body Mass Index; D004359:Drug Therapy, Combination; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D009518:New York; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D010818:Practice Patterns, Physicians'; D012112:Residential Facilities / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D020246:Venous Thrombosis / Q000188:drug therapy*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin