title: Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach.
abstract: BACKGROUND
  Atrial fibrillation (AF) in the elderly is a complex condition. It has a direct impact on the underuse of antithrombotic therapy reported in this population.
  
  
  CONCLUSIONS
  All patients aged ≥75 years with AF have an individual yearly risk of stroke >4 %. However, the risk of hemorrhage is also increased. Moreover, in this population it is common the presence of other comorbidities, cognitive disorders, risk of falls and polymedication. This may lead to an underuse of anticoagulant therapy. Direct oral anticoagulants (DOACs) are at least as effective as conventional therapy, but with lesser risk of intracranial hemorrhage. The simplification of treatment with these drugs may be an advantage in patients with cognitive impairment. The great majority of elderly patients with AF should receive anticoagulant therapy, unless an unequivocal contraindication. DOACs may be the drugs of choice in many elderly patients with AF. In this manuscript, the available evidence about the management of anticoagulation in elderly patients with AF is reviewed. In addition, specific practical recommendations about different controversial issues (i.e. patients with anemia, thrombocytopenia, risk of gastrointestinal bleeding, renal dysfunction, cognitive impairment, risk of falls, polymedication, frailty, etc.) are provided.
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez Fernández
authors.affiliation: Hospital Universitario de La Princesa, Grupo de Riesgo Vascular de la SEMI, Madrid, España. csuarezf@salud.madrid.org.|Servicio de Medicina Interna, Hospital Universitario de La Princesa, C/Diego de León 62, 28006, Madrid, Spain. csuarezf@salud.madrid.org.
authors.forename: Suárez
authors.initials: S
authors.lastname: Fernández
authors.affiliation: Hospital Universitari de Bellvitge, Grupo de Riesgo Vascular de la SEMI, Hospitalet de Llobregat, Barcelona, España.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Atrial Fibrillation Unit (UFA), Internal Medicine Department, Hospital Clinic. University of Barcelona. Research Group in Cardiovascular Risk, Nutrition and Aging. Area. 'August Pi i Sunyer' Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Camafort
authors.forename: María
authors.initials: M
authors.lastname: Cepeda Rodrigo
authors.affiliation: Hospital Vega Baja de Orihuela, Grupo de Riesgo Vascular de la SEMI, Orihuela, Alicante, España.
authors.forename: Jose Cepeda
authors.initials: JC
authors.lastname: Rodrigo
authors.affiliation: Hospital Royo Villanova, Grupo de Riesgo Vascular de la SEMI, Zaragoza, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Díez-Manglano
authors.forename: Antonio
authors.initials: A
authors.lastname: Pose Reino
authors.affiliation: Complexo Hospitalario Universitario de Santiago, Grupo de Riesgo Vascular de la SEMI, Santiago de Compostela, España.
authors.forename: Pose
authors.initials: P
authors.lastname: Reino
authors.affiliation: Hospital Virgen del Camino, Grupo de Riesgo Vascular de la SEMI, Pamplona, España.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tiberio
authors.affiliation: Hospital Carlos III, Grupo de Riesgo Vascular de la SEMI, Madrid, España.
authors.forename: Jose María
authors.initials: JM
authors.lastname: Mostaza
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D003072:Cognition Disorders / Q000150:complications; D000075202:Contraindications; D004359:Drug Therapy, Combination; D016330:Frail Elderly; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D055118:Medication Adherence; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*; D013921:Thrombocytopenia / Q000150:complications
chemical_list: D000925:Anticoagulants