Anticoagulation in Older Adults with Multimorbidity.
The number of patients with atrial fibrillation (AF) who are of advanced age or have multiple comorbidities is expected to increase substantially. Older patients with AF generally gain a net benefit from anticoagulation. Guidelines typically recommend anticoagulation. There are multiple challenges in the safe use of anticoagulation in frail patients, including bleeding risk, monitoring and adherence, and polypharmacy. Although there are options for chronic oral anticoagulation, clinicians must understand the unique advantages and disadvantages of these medications when developing a management plan. This article reviews issues surrounding the appropriate use and selection of anticoagulants in complex older patients with AF.
Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
Anna L
AL
Parks
Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Avenue, Box 0131, San Francisco, CA 94143, USA. Electronic address: Margaret.fang@ucsf.edu.
Margaret C
MC
Fang
D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D015897:Comorbidity; D006801:Humans; D018579:Patient Selection; D020379:Risk Adjustment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants
Anticoagulation; Atrial fibrillation; Bleeding risk; Multimorbidity; New oral anticoagulants; Polypharmacy; Warfarin